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General NPI Number Information
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NPI Number | 1679108252
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Entity Type | Individual
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Provider Name | CASSANDRA MARIE BOISSONNEAULT APRN
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Gender | Female
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Dates
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Enumeration Date | 03/04/2020
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Last Update Date | 05/08/2023
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Provider Practice Location Address
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Address Line | 928 RIVERDALE ST
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City | WEST SPRINGFIELD
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State | MA
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Zip | 01089-4620
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Country | US
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Telephone | 413-733-6490
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Fax |
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Provider Business Mailing Address
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Address Line | 46 DAGGETT DR STE 1A
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City | WEST SPRINGFIELD
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State | MA
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Zip | 01089-4646
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Country | US
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Telephone | 413-707-7720
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN2267232
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License Number State | MA
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