Healthcare Provider Details

I. General information

NPI: 1003904293
Provider Name (Legal Business Name): DANA MARIE MCCABE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4929 COUNTY ROAD P43 FORT CALHOUN CLINIC
FORT CALHOUN NE
68023
US

IV. Provider business mailing address

4929 COUNTY ROAD P43
FORT CALHOUN NE
68023-5066
US

V. Phone/Fax

Practice location:
  • Phone: 402-468-4655
  • Fax: 402-468-4633
Mailing address:
  • Phone: 402-468-4655
  • Fax: 402-468-4633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1003
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: