| NPI | 1073921565 |
|---|---|
| Former Name | CASSANDRA LYNN GRAVLIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2014025546) |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2014-07-28 |