Provider Demographics
NPI:1043015845
Name:POTTER, CASSANDRA J
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:J
Last Name:POTTER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 LAVERNA ST APT 47
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2427
Mailing Address - Country:US
Mailing Address - Phone:402-720-5643
Mailing Address - Fax:
Practice Address - Street 1:2600 LAVERNA ST APT 45
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2427
Practice Address - Country:US
Practice Address - Phone:402-720-5643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide