Provider Demographics
NPI:1780925404
Name:MACCORD, LIZBETH GABEL (RN)
Entity type:Individual
Prefix:MS
First Name:LIZBETH
Middle Name:GABEL
Last Name:MACCORD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:527 COBB ST
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-2540
Mailing Address - Country:US
Mailing Address - Phone:231-775-3463
Mailing Address - Fax:231-775-1692
Practice Address - Street 1:527 COBB ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2540
Practice Address - Country:US
Practice Address - Phone:231-775-3463
Practice Address - Fax:231-775-1692
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704184078163W00000X, 163WC0400X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult