Provider Demographics
NPI:1417426966
Name:MCCABE, MARTHA MARY (APRN)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:MARY
Last Name:MCCABE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 N NEWBERRY ST
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-2292
Mailing Address - Country:US
Mailing Address - Phone:316-308-2720
Mailing Address - Fax:
Practice Address - Street 1:2100 N WALDRON ST
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-1175
Practice Address - Country:US
Practice Address - Phone:620-833-0960
Practice Address - Fax:833-615-2260
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2022-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-78400-012363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily