Healthcare Provider Details

I. General information

NPI: 1669323739
Provider Name (Legal Business Name): HYDRACORE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2026
Last Update Date: 02/05/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

674 EAST MAIN STREET
HEGINS PA
17938
US

IV. Provider business mailing address

283 SCHWENKS RD
HEGINS PA
17938-9701
US

V. Phone/Fax

Practice location:
  • Phone: 570-294-6725
  • Fax:
Mailing address:
  • Phone: 570-294-6725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MADISON MAURER
Title or Position: OWNER
Credential: CRNP
Phone: 570-294-6725