=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760595607
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NORA LEE MCCANNA BSSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 515 S PARKER ST SUITE D
-----------------------------------------------------
City | MARINE CITY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48039-3572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-765-5010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4252 NORTH RIVER ROAD
-----------------------------------------------------
City | FORT GRATIOT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-985-5822
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | L881697
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------