Provider Demographics
NPI:1114409125
Name:MCCANTS, MIIA (CD)
Entity Type:Individual
Prefix:
First Name:MIIA
Middle Name:
Last Name:MCCANTS
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 IGNICO DR APT 103-4
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-8670
Mailing Address - Country:US
Mailing Address - Phone:973-752-7845
Mailing Address - Fax:
Practice Address - Street 1:135 IGNICO DR APT 103-4
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-8670
Practice Address - Country:US
Practice Address - Phone:973-752-7845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2022-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
NJ26NP07354300164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No374J00000XNursing Service Related ProvidersDoula