MEDICARE: MRS. TRINA RAE MCPHERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1336492032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRINA RAE MCPHERSON

Provider Business Mailing Address
First Line	:	PO BOX 818
Second Line	:
City	:	MCCOOK
State	:	NE
Zip	:	69001-0818
Country	:	US
Telephone Number	:	308-345-2770
Fax Number	:	308-345-2557

Provider Business Practice Location Address
First Line	:	1012 WEST THIRD
Second Line	:
City	:	MCCOOK
State	:	NE
Zip	:	69001-2527
Country	:	US
Telephone Number	:	308-345-2770
Fax Number	:	308-345-2557

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2012
Last Update Date	:	10/18/2012

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