Provider Demographics
NPI:1316005721
Name:MCCANN, SUZANNE KATHLEEN (LVN)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:KATHLEEN
Last Name:MCCANN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:587 N VENTU PARK RD
Mailing Address - Street 2:E4
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-2723
Mailing Address - Country:US
Mailing Address - Phone:805-657-5083
Mailing Address - Fax:805-480-0383
Practice Address - Street 1:587 N VENTU PARK RD
Practice Address - Street 2:E4
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-2723
Practice Address - Country:US
Practice Address - Phone:805-480-0383
Practice Address - Fax:805-480-0383
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN178413164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARVN003220Medicaid
CAESP014880Medicaid