Provider Demographics
NPI:1417297334
Name:MCCANN, RAQUEL ALEXIS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:ALEXIS
Last Name:MCCANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RAQUEL
Other - Middle Name:ALEXIS
Other - Last Name:POORMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 MEDICAL PAVILION DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-0019
Mailing Address - Country:US
Mailing Address - Phone:910-904-8025
Mailing Address - Fax:
Practice Address - Street 1:300 MEDICAL PAVILION DR
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-0019
Practice Address - Country:US
Practice Address - Phone:910-904-8025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04037363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant