Waterman, Cassidy B

Waterman, Cassidy B is an individual health care provider with primary practice located at 1950 E Clark St Suite G, Pocatello ID 83201-3314. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Waterman, Cassidy B can be contacted via phone (208) 232-7760.

Contact Information

Primary practice address
1950 E Clark St Suite G Pocatello ID 83201-3314
Phone: (208) 232-7760
Fax: (208) 232-1950
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X RNA-781 Idaho

Profile Details

NPI number 1750691929
LBN Legal business name Waterman, Cassidy B
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 20th, 2010
Last updated Oct 19th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750691929 NPPES
Idaho Other CD5673 RR GROUP LEGACY NUMBER
Idaho Other P00956855 RR GROUP LEGACY NUMBER
Idaho Other 1604930 RR GROUP LEGACY NUMBER

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