Provider Demographics
NPI:1720317852
Name:MCCABE, DONNA M (STNA)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:M
Last Name:MCCABE
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 YALE AVE LOT 44
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44905-1577
Mailing Address - Country:US
Mailing Address - Phone:419-775-5238
Mailing Address - Fax:
Practice Address - Street 1:741 YALE AVE LOT 44
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44905-1577
Practice Address - Country:US
Practice Address - Phone:419-775-5238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-20
Last Update Date:2009-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH363454371189E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$Medicaid