Healthcare Provider Details

I. General information

NPI: 1316675341
Provider Name (Legal Business Name): MICHAEL MCCABE RN, BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 08/09/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4372 SW SCHOOL RD
HIGH POINT NC
27265-8150
US

IV. Provider business mailing address

2305 CRESTVIEW WAY
WINSTON SALEM NC
27103-9772
US

V. Phone/Fax

Practice location:
  • Phone: 336-819-2992
  • Fax:
Mailing address:
  • Phone: 336-825-7077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number284112
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: