Provider Demographics
NPI:1275687246
Name:MCBRIDE, NANCY K (PAC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:K
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 CLINE AVE STE B3
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1057
Mailing Address - Country:US
Mailing Address - Phone:419-756-9995
Mailing Address - Fax:419-756-9921
Practice Address - Street 1:370 CLINE AVE STE B3
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1057
Practice Address - Country:US
Practice Address - Phone:419-756-9995
Practice Address - Fax:419-756-9921
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-002017363A00000X
OH50.002017RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0123320Medicaid
Q36424Medicare UPIN