Provider Demographics
NPI:1437035516
Name:MISCEVIC, CASSIE L (APRN, CNP)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:L
Last Name:MISCEVIC
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:L
Other - Last Name:RODRIQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:427 N WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OGLESBY
Mailing Address - State:IL
Mailing Address - Zip Code:61348-1175
Mailing Address - Country:US
Mailing Address - Phone:815-252-9900
Mailing Address - Fax:
Practice Address - Street 1:1505 EASTLAND DR STE 1000
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-7905
Practice Address - Country:US
Practice Address - Phone:309-661-6270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.032958363LX0106X
IL209032958363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health