Healthcare Provider Details

I. General information

NPI: 1740043850
Provider Name (Legal Business Name): GERALYN MCCANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 02/01/2024
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1374 W FRONTAGE RD
RIO RICO AZ
85648-6377
US

IV. Provider business mailing address

1374 W FRONTAGE RD
RIO RICO AZ
85648-6377
US

V. Phone/Fax

Practice location:
  • Phone: 520-281-8282
  • Fax:
Mailing address:
  • Phone: 520-375-8507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number256019
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: