Provider Demographics
NPI:1053803122
Name:MCCABE, KATHERINE (LPN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:MCCABE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 COBBLERIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-2522
Mailing Address - Country:US
Mailing Address - Phone:631-522-3379
Mailing Address - Fax:631-289-5216
Practice Address - Street 1:59 COBBLERIDGE LN
Practice Address - Street 2:
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-2522
Practice Address - Country:US
Practice Address - Phone:631-522-3379
Practice Address - Fax:631-289-5216
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324129164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse