MEDICARE: MARCANN HEALTH ALLIANCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1942000955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARCANN HEALTH ALLIANCE

Provider Business Mailing Address
First Line	:	13925 W MEEKER BLVD STE 18
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85375-4432
Country	:	US
Telephone Number	:	602-824-9309
Fax Number	:

Provider Business Practice Location Address
First Line	:	13925 W MEEKER BLVD STE 18
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85375-4432
Country	:	US
Telephone Number	:	602-824-9309
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	STEVEN DOMANN
Credential	:	PSY.D
Telephone Number	:	602-824-9309

Provider Enumeration Date	:	03/18/2025
Last Update Date	:	04/07/2025

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