Healthcare Provider Details

I. General information

NPI: 1124645007
Provider Name (Legal Business Name): JOHN WILLIAM CANN MSN, FNP-BC, APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOHN WILLIAM CANN MSN, FNP-C, APRN

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 BROADWAY
REVERE MA
02151-2347
US

IV. Provider business mailing address

111 DERBY RD
REVERE MA
02151-1803
US

V. Phone/Fax

Practice location:
  • Phone: 617-285-8731
  • Fax:
Mailing address:
  • Phone: 617-285-8731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License NumberRN2298986
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberRN2298986
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN2298986
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2298986
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: