Healthcare Provider Details

I. General information

NPI: 1679378822
Provider Name (Legal Business Name): SANDRA MARNITA MCCANN BSN, RN, CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 NEALY AVE MEDICAL CASE MANAGEMENT -SGHM
HAMPTON VA
23665-2080
US

IV. Provider business mailing address

703 MILFORD AVE
HAMPTON VA
23661-1141
US

V. Phone/Fax

Practice location:
  • Phone: 757-225-6732
  • Fax: 757-764-0968
Mailing address:
  • Phone: 757-880-4294
  • Fax: 757-764-0968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number604739
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: