Provider Demographics
NPI:1194778340
Name:RIVERS, CASSANDRA A (CRNA)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:A
Last Name:RIVERS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2476
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-2476
Mailing Address - Country:US
Mailing Address - Phone:307-638-0300
Mailing Address - Fax:307-638-0394
Practice Address - Street 1:214 E 23RD ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3748
Practice Address - Country:US
Practice Address - Phone:307-638-0300
Practice Address - Fax:307-638-0394
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY19253.705367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY115279300Medicaid
NE10024962200Medicaid
WY308213OtherBLUE CROSS BLUE SHIELD
WYR79841Medicare UPIN
WYW308213Medicare ID - Type Unspecified
WY430051852Medicare ID - Type UnspecifiedRAILROAD MEDICARE