Provider Demographics
NPI:1841216280
Name:CASSELLA, NANCY A (MN)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:CASSELLA
Suffix:
Gender:F
Credentials:MN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 BLANCHARD RD
Mailing Address - Street 2:
Mailing Address - City:MONSON
Mailing Address - State:ME
Mailing Address - Zip Code:04464-6600
Mailing Address - Country:US
Mailing Address - Phone:207-997-3578
Mailing Address - Fax:
Practice Address - Street 1:68 BLANCHARD RD
Practice Address - Street 2:
Practice Address - City:MONSON
Practice Address - State:ME
Practice Address - Zip Code:04464-6600
Practice Address - Country:US
Practice Address - Phone:207-997-3578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81519363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000224801OtherPTAN
S92356Medicare UPIN
ME000224801OtherPTAN