Provider Demographics
NPI:1497751515
Name:MCCASKILL, CHENELLE D (PA)
Entity Type:Individual
Prefix:
First Name:CHENELLE
Middle Name:D
Last Name:MCCASKILL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2570 NW EDENBOWER BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471
Mailing Address - Country:US
Mailing Address - Phone:541-957-1111
Mailing Address - Fax:541-229-3335
Practice Address - Street 1:2570 NW EDENBOWER BLVD
Practice Address - Street 2:STE 100
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471
Practice Address - Country:US
Practice Address - Phone:541-957-1111
Practice Address - Fax:541-229-3335
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2015-06-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORPA01103363AS0400X
ORPA1103363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORQ43651Medicare UPIN
ORR133948Medicare PIN