Provider Demographics
NPI:1629629555
Name:MCCABE, RENE (LPN)
Entity Type:Individual
Prefix:MS
First Name:RENE
Middle Name:
Last Name:MCCABE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4687 STATE ROUTE 88
Mailing Address - Street 2:
Mailing Address - City:SODUS
Mailing Address - State:NY
Mailing Address - Zip Code:14551-9721
Mailing Address - Country:US
Mailing Address - Phone:315-573-8910
Mailing Address - Fax:
Practice Address - Street 1:4687 STATE ROUTE 88
Practice Address - Street 2:
Practice Address - City:SODUS
Practice Address - State:NY
Practice Address - Zip Code:14551-9721
Practice Address - Country:US
Practice Address - Phone:315-573-8910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245971164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse