Provider Demographics
NPI:1992321863
Name:PRENDERGAST, CASSIE DEANN (DNP)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:DEANN
Last Name:PRENDERGAST
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:DEANN
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36 GOOSE COVE LN
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-6531
Mailing Address - Country:US
Mailing Address - Phone:361-720-5423
Mailing Address - Fax:
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3134
Practice Address - Country:US
Practice Address - Phone:207-221-4286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN88398163W00000X
MERNA243064367500000X
PA128066367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse