Healthcare Provider Details

I. General information

NPI: 1609768076
Provider Name (Legal Business Name): MIKAYLA CANN DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 07/18/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THEDACARE REGIONAL MEDICAL CENTER-APPLETON 1818 N MEADE STREET
APPLETON WI
54911
US

IV. Provider business mailing address

W6428 SONNY DR APT 222
MENASHA WI
54952-0047
US

V. Phone/Fax

Practice location:
  • Phone: 920-454-2169
  • Fax:
Mailing address:
  • Phone: 608-213-2014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17114-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: