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General NPI Number Information
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NPI Number | 1710185079
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Entity Type | Individual
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Provider Name | LISE MICHELLE MCCANLESS APRN
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Gender | Female
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 07/01/2016
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Provider Practice Location Address
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Address Line | 8831 IMMOKALEE RD
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City | NAPLES
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State | FL
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Zip | 34120-3914
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Country | US
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Telephone | 757-457-5100
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Fax | 757-819-7762
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Provider Business Mailing Address
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Address Line | 380 TERN DR APT 3
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City | NAPLES
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State | FL
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Zip | 34112-3922
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Country | US
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Telephone | 757-457-5100
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Fax | 757-819-7762
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9876
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License Number State | VI
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0024118550
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9436627
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License Number State | FL
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