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General NPI Number Information
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NPI Number | 1114869187
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Entity Type | Individual
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Provider Name | JOHN SCANLON
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Gender | Male
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Dates
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Enumeration Date | 04/08/2026
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Last Update Date | 04/08/2026
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Provider Practice Location Address
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Address Line | 2215 FULLER RD
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City | ANN ARBOR
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State | MI
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Zip | 48105-2303
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Country | US
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Telephone | 734-845-3659
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Fax |
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Provider Business Mailing Address
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Address Line | 1070 HAWTHORNE AVE
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City | YPSILANTI
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State | MI
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Zip | 48198-5826
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Country | US
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Telephone | 734-845-3659
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Fax | 734-845-3272
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WN0300X
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Taxonomy Name | Nephrology Registered Nurse
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License Number | 4704290963
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License Number State | MI
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