Provider Demographics
NPI:1104439124
Name:MCBANE, CAROLINE NELSON (PA)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:NELSON
Last Name:MCBANE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1130 N CHURCH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1041
Mailing Address - Country:US
Mailing Address - Phone:336-235-3105
Mailing Address - Fax:336-375-2314
Practice Address - Street 1:1130 N CHURCH ST STE 100
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1041
Practice Address - Country:US
Practice Address - Phone:336-375-2300
Practice Address - Fax:336-375-2314
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-09951363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant