=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720317852
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONNA M MCCABE STNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2009
-----------------------------------------------------
Last Update Date | 12/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 741 YALE AVE LOT 44
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44905-1577
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-775-5238
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 741 YALE AVE LOT 44
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44905-1577
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-775-5238
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376K00000X
-----------------------------------------------------
Taxonomy Name | Nurse's Aide
-----------------------------------------------------
License Number | 363454371189E
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------