Provider Demographics
NPI:1538400213
Name:MCCABE, STACY R (LPN)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:R
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 1:20 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-3211
Mailing Address - Country:US
Mailing Address - Phone:631-447-5891
Mailing Address - Fax:
Practice Address - Street 1:20 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-3211
Practice Address - Country:US
Practice Address - Phone:631-447-5891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7569344164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse