Provider Demographics
NPI:1619982295
Name:CABAN, AMI MARIE (PA)
Entity Type:Individual
Prefix:
First Name:AMI
Middle Name:MARIE
Last Name:CABAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13620 REESE BLVD E
Practice Address - Street 2:STE 100
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6417
Practice Address - Country:US
Practice Address - Phone:704-801-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00283215OtherRAILROAD MEDICARE
NC2760092GMedicare PIN
NC2760092AMedicare ID - Type Unspecified
NC2760092DMedicare UPIN
NCP72674Medicare UPIN