Provider Demographics
NPI:1336405125
Name:MAINGRETTE, CASSANDRA ALTAGRACIA (NP)
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:ALTAGRACIA
Last Name:MAINGRETTE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:ALTAGRACIA
Other - Middle Name:CASSANDRA
Other - Last Name:DUVIVIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1123 ALBERT RD
Mailing Address - Street 2:
Mailing Address - City:N BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-2747
Mailing Address - Country:US
Mailing Address - Phone:516-850-5512
Mailing Address - Fax:
Practice Address - Street 1:1123 ALBERT RD
Practice Address - Street 2:
Practice Address - City:N BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-2747
Practice Address - Country:US
Practice Address - Phone:516-850-5512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2023-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY640846-1163W00000X
NYF347366-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse