Individual provider · NPI-1

Cassandra Jean Bommersbach

Nurse Practitioner, Women's Health · Bemidji, MN

NPI number1821831629
StatusActive
Last updated in NPPESJul 31, 2024

Details

NPI
1821831629
Entity type
Individual (NPI-1)
Name
Cassandra Jean Bommersbach
Sex
Female
Sole proprietor
No
Enumeration date
Jun 18, 2024
Certification date
Jul 31, 2024
Last updated
Jul 31, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LW0102X Nurse Practitioner, Women's Health11693MNYes
363LF0000X Nurse Practitioner, Family11693MN

Practice location

1233 34th St Nw
Bemidji, MN 56601-5112

Phone 612-807-8626

Mailing address

Po Box 5074
Sioux Falls, SD 57117-5074

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