MEDICARE: KRISTEN LEE MCCANN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	183761	CO

General Provider Information

NPI Number	:	1063782159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN LEE MCCANN RN

Provider Business Mailing Address
First Line	:	9695 S YOSEMITE ST
Second Line	:
City	:	LONETREE
State	:	CO
Zip	:	80124-2888
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9695 S YOSEMITE ST
Second Line	:
City	:	LONETREE
State	:	CO
Zip	:	80124-2888
Country	:	US
Telephone Number	:	303-338-4545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2012
Last Update Date	:	01/05/2012

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