Healthcare Provider Details

I. General information

NPI: 1285379883
Provider Name (Legal Business Name): CASSIE HOBERECHT CRM-I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 NE ELM ST
PRINEVILLE OR
97754-1664
US

IV. Provider business mailing address

PO BOX MM
MADRAS OR
97741-0136
US

V. Phone/Fax

Practice location:
  • Phone: 541-306-4566
  • Fax: 541-320-9005
Mailing address:
  • Phone: 541-777-7847
  • Fax: 541-512-7090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: