Provider Demographics
NPI:1639963630
Name:MAUK, CASSIDY (CRNP)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:MAUK
Suffix:
Gender:
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 TREASURE LAKE
Mailing Address - Street 2:17161 TREASURE LAKE ROAD
Mailing Address - City:DUBOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801
Mailing Address - Country:US
Mailing Address - Phone:814-591-5819
Mailing Address - Fax:
Practice Address - Street 1:145 HOSPITAL AVE STE 211
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1464
Practice Address - Country:US
Practice Address - Phone:814-375-3722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP032602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily