Provider Demographics
NPI:1689934945
Name:CASSIDY, MARYLOU (APRN)
Entity Type:Individual
Prefix:
First Name:MARYLOU
Middle Name:
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 REAVELEY RD
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:NH
Mailing Address - Zip Code:03449-5501
Mailing Address - Country:US
Mailing Address - Phone:603-525-4786
Mailing Address - Fax:
Practice Address - Street 1:1283 MAIN ST UNIT 6C
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:NH
Practice Address - Zip Code:03444-8249
Practice Address - Country:US
Practice Address - Phone:603-831-1191
Practice Address - Fax:833-924-0345
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH046567-23363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily