Provider Demographics
NPI:1437815040
Name:DR JENNI L MCCANN CORPORATION
Entity Type:Organization
Organization Name:DR JENNI L MCCANN CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNI
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, ARNP, PMHNP-BC
Authorized Official - Phone:563-590-1399
Mailing Address - Street 1:2600 DODGE ST STE D5
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-7161
Mailing Address - Country:US
Mailing Address - Phone:563-590-1399
Mailing Address - Fax:
Practice Address - Street 1:2600 DODGE ST STE D5
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52003-7161
Practice Address - Country:US
Practice Address - Phone:563-590-1399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty