=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083075626
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CASSANDRA BOOZEL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2016
-----------------------------------------------------
Last Update Date | 01/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 HIGHLAND AVE
-----------------------------------------------------
City | LEWISTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17044-1167
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-248-5411
-----------------------------------------------------
Fax | 717-242-7581
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 SUMMIT DR
-----------------------------------------------------
City | MIFFLIN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17058-9767
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-363-1865
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | SP016065
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------