Provider Demographics
NPI:1487641676
Name:CASSIDY, CATHERINE A (PHD, APN-C)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:PHD, APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 DURAND RD
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-1245
Mailing Address - Country:US
Mailing Address - Phone:973-762-0540
Mailing Address - Fax:
Practice Address - Street 1:36 MADISON AVE
Practice Address - Street 2:DREW UNIVERSITY HEALTH SERVICE
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-1434
Practice Address - Country:US
Practice Address - Phone:973-408-3414
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN02122100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily