Provider Demographics
NPI:1255325213
Name:MCCABE, WENDY MARION NELMS (MD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:MARION NELMS
Last Name:MCCABE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3585 LEXINGTON AVE N
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-8064
Mailing Address - Country:US
Mailing Address - Phone:651-251-5280
Mailing Address - Fax:651-251-5282
Practice Address - Street 1:3585 LEXINGTON AVE N
Practice Address - Street 2:SUITE 350
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8064
Practice Address - Country:US
Practice Address - Phone:651-484-3942
Practice Address - Fax:651-787-0519
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN416782080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCP9091026080OtherPREFERRED ONE
MN1201042OtherMEDICA
MN1201039OtherMEDICA
MN299L4MCMedicaid
MN1201042OtherMEDICA