Provider Demographics
NPI:1194471243
Name:CRNICH, CASSANDRA (CIAYT)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:CRNICH
Suffix:
Gender:F
Credentials:CIAYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-4246
Mailing Address - Country:US
Mailing Address - Phone:406-498-0751
Mailing Address - Fax:
Practice Address - Street 1:2713 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-4246
Practice Address - Country:US
Practice Address - Phone:406-498-0751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date: