Healthcare Provider Details

I. General information

NPI: 1255564209
Provider Name (Legal Business Name): DANA MARIE MCCABE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 HARRISON AVE YACC 3
BOSTON MA
02118-4001
US

IV. Provider business mailing address

850 HARRISON AVE YACC BN-C7
BOSTON MA
02118-4001
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-2080
  • Fax: 617-414-2090
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN284303
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN284303
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: