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General NPI Number Information
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NPI Number | 1669323739
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Entity Type | Organization
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Legal Business Name | HYDRACORE WELLNESS LLC
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Dates
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Enumeration Date | 02/05/2026
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 674 EAST MAIN STREET
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City | HEGINS
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State | PA
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Zip | 17938
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Country | US
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Telephone | 570-294-6725
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Fax |
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Provider Business Mailing Address
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Address Line | 283 SCHWENKS RD
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City | HEGINS
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State | PA
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Zip | 17938-9701
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Country | US
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Telephone | 570-294-6725
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MADISON MAURER
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Credential | CRNP
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Telephone | 570-294-6725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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