Provider Demographics
NPI:1104912369
Name:MCCABE, ELLEN BUNTEN (APRN BC GNP)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:BUNTEN
Last Name:MCCABE
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Gender:F
Credentials:APRN BC GNP
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DIVISION OF NEOPLASTIC DISEASES
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-6800
Mailing Address - Fax:414-805-6805
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DIVISION OF NEOPLASTIC DISEASES
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-6800
Practice Address - Fax:414-805-6805
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2016-04-29
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Provider Licenses
StateLicense IDTaxonomies
WI2072-33363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1104912369Medicaid
WI1079 73-601Medicare PIN