Provider Demographics
NPI:1831507540
Name:CASSIDY, BROOKE M (CNP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:M
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:CNP
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 312
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:OH
Mailing Address - Zip Code:45875-0312
Mailing Address - Country:US
Mailing Address - Phone:419-523-4449
Mailing Address - Fax:419-523-6328
Practice Address - Street 1:575 O-G ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875-9426
Practice Address - Country:US
Practice Address - Phone:419-523-4449
Practice Address - Fax:419-523-6328
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16231-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health