Individual
JASON LEO CASSIDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
701 N 1ST ST, SPRINGFIELD, IL 62781-2329
(217) 788-3000
Mailing address
701 N 1ST ST, SPRINGFIELD, IL 62781-0001
(217) 788-3000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
2001022867
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
209.020724
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209020724
CRNA LICENSE
IL
05
—
919107201
—
MO
01
—
P00133340
RAILROAD MEDICARE
MO
Enumeration date
06/25/2005
Last updated
02/11/2020
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