Individual
MR. RANDALL L CASSIDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
1120 E BROAD ST, ELYRIA, OH 44035-6306
(440) 365-2239
(440) 365-1366
Mailing address
PO BOX 636643, CINCINNATI, OH 45263-6643
(440) 366-2239
(440) 365-1366
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
258009
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0236248
—
OH
01
—
11937343
CAQH
OH
05
—
2914234
—
OH
05
—
3025372
—
OH
Enumeration date
10/09/2008
Last updated
11/04/2014
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