Provider Demographics
NPI:1588360556
Name:VINSON, CASSANDRA G (CNA, PBT)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:G
Last Name:VINSON
Suffix:
Gender:F
Credentials:CNA, PBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4246 S EIDER CIR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99623-9863
Mailing Address - Country:US
Mailing Address - Phone:907-315-6073
Mailing Address - Fax:
Practice Address - Street 1:4246 S EIDER CIR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99623-9863
Practice Address - Country:US
Practice Address - Phone:907-315-6073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
R4Y7H7K4225800000X
73543246RP1900X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoula
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Single Specialty
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy