Healthcare Provider Details

I. General information

NPI: 1760595607
Provider Name (Legal Business Name): NORA LEE MCCANNA BSSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S PARKER ST SUITE D
MARINE CITY MI
48039-3572
US

IV. Provider business mailing address

4252 NORTH RIVER ROAD
FORT GRATIOT MI
48059
US

V. Phone/Fax

Practice location:
  • Phone: 810-765-5010
  • Fax:
Mailing address:
  • Phone: 810-985-5822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberL881697
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: