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General NPI Number Information
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NPI Number | 1912179144
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Entity Type | Organization
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Legal Business Name | SUSAN MCCABE APRN BC INC
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 104 S 4TH ST
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City | LARAMIE
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State | WY
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Zip | 82070-3162
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Country | US
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Telephone | 307-760-0510
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 547
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City | LARAMIE
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State | WY
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Zip | 82073-0547
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Country | US
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Telephone | 307-760-0510
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN MCCABE
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Credential | APRN BC
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Telephone | 307-760-0510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State | WY
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