Individual
SAMANTHA NICHOLE CASSITY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2707 15TH PL, KENOSHA, WI 53140-4947
(262) 551-2700
Mailing address
2707 15TH PL, KENOSHA, WI 53140-4947
(262) 551-2700
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
13824
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100242210
—
WI
Enumeration date
05/01/2023
Last updated
10/06/2023
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