MEDICARE: MICHAELA ELDER MCCALL FNP

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	363LF0000X	Family Nurse Practitioner	5010783	NC

General Provider Information

NPI Number	:	1578040143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAELA ELDER MCCALL FNP

Provider Business Mailing Address
First Line	:	2872 S NC 127 HWY
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28602-9131
Country	:	US
Telephone Number	:	828-330-2103
Fax Number	:

Provider Business Practice Location Address
First Line	:	2872 S NC 127 HWY
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28602
Country	:	US
Telephone Number	:	828-330-2103
Fax Number	:

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

Provider Enumeration Date	:	07/25/2018
Last Update Date	:	08/21/2018

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