Provider Demographics
NPI:1821127796
Name:MABE, DAVID ODELL (FNPC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ODELL
Last Name:MABE
Suffix:
Gender:M
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1593 YANCEYVILLE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-6948
Mailing Address - Country:US
Mailing Address - Phone:336-230-0402
Mailing Address - Fax:336-230-1761
Practice Address - Street 1:1593 YANCEYVILLE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6948
Practice Address - Country:US
Practice Address - Phone:336-230-0402
Practice Address - Fax:336-230-1761
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201234363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS91718Medicare UPIN