Healthcare Provider Details

I. General information

NPI: 1225992241
Provider Name (Legal Business Name): MARYANNE CANN LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2025
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 HARTSHORN ST
DANIELSON CT
06239-4118
US

IV. Provider business mailing address

5 HARTSHORN ST
DANIELSON CT
06239-4118
US

V. Phone/Fax

Practice location:
  • Phone: 774-365-0522
  • Fax:
Mailing address:
  • Phone: 774-365-0522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLN100731
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: