Basic Information
| Provider Information | |||||||||
| NPI: | 1457922072 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAYDICK | ||||||||
| FirstName: | MEAGHAN | ||||||||
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| Credential: | DNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12 VAN BUREN CIR | ||||||||
| Address2: | |||||||||
| City: | MC KEES ROCKS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151361797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104426039 | ||||||||
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| Practice Location | |||||||||
| Address1: | 133 CHUCH HILL ROAD | ||||||||
| Address2: | SUITE 2A | ||||||||
| City: | MCKEES ROCKS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4127221003 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2021 | ||||||||
| LastUpdateDate: | 12/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP023825 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | SP023825 | 01 | PA | CRNP LICENSE NUMBER | OTHER |