Individual
CASSANDRA D. WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA - C
Contact information
Practice address
825 FAIRFAX AVE, SUITE 545, NORFOLK, VA 23507-1914
(757) 446-8999
(757) 446-7922
Mailing address
PO BOX 936, EVMS HEALTH SERVICES, NORFOLK, VA 23501-0936
(757) 446-8999
(757) 446-7922
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110004025
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
-032
TRICARE/CHAMPUS
VA
01
—
10102992P
OPTIMA HEALTH
VA
05
—
1497030076
—
VA
05
—
8102983
—
NC
01
—
PAR
USA MANAGED CARE
VA
Enumeration date
10/14/2011
Last updated
02/11/2013
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