Provider Demographics
NPI:1669941142
Name:BOLDUC, CASSIE L (CNS)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:L
Last Name:BOLDUC
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 N MARR RD STE B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-2610
Mailing Address - Country:US
Mailing Address - Phone:812-375-0272
Mailing Address - Fax:812-375-1093
Practice Address - Street 1:940 N MARR RD STE B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-2610
Practice Address - Country:US
Practice Address - Phone:812-375-0272
Practice Address - Fax:812-375-1093
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28160216A364S00000X
IN71008787A364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist