Healthcare Provider Details

I. General information

NPI: 1427379353
Provider Name (Legal Business Name): CASSIDY JO BOYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 11TH ST N
COLUMBUS MT
59019-7215
US

IV. Provider business mailing address

PO BOX 932759
CLEVELAND OH
44193-0015
US

V. Phone/Fax

Practice location:
  • Phone: 406-322-1000
  • Fax:
Mailing address:
  • Phone: 937-293-8228
  • Fax: 937-293-8229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.13720
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: