Provider Demographics
NPI:1457922072
Name:MAYDICK, MEAGHAN (DNP)
Entity Type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:
Last Name:MAYDICK
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 VAN BUREN CIR
Mailing Address - Street 2:
Mailing Address - City:MC KEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136-1797
Mailing Address - Country:US
Mailing Address - Phone:610-442-6039
Mailing Address - Fax:
Practice Address - Street 1:133 CHUCH HILL ROAD
Practice Address - Street 2:SUITE 2A
Practice Address - City:MCKEES ROCKS
Practice Address - State:PA
Practice Address - Zip Code:15136
Practice Address - Country:US
Practice Address - Phone:412-722-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP023825363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP023825OtherCRNP LICENSE NUMBER