Healthcare Provider Details

I. General information

NPI: 1306360763
Provider Name (Legal Business Name): AMY E MCCABE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY ELIZABETH VAN ASTEN PA-C

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S PARK ST
MADISON WI
53715-1830
US

IV. Provider business mailing address

1808 W BELTLINE HWY
MADISON WI
53713-2334
US

V. Phone/Fax

Practice location:
  • Phone: 608-260-2900
  • Fax: 608-260-2956
Mailing address:
  • Phone: 608-280-4647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4181-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: