Provider Demographics
NPI:1669665113
Name:MCCORMICK, JAN (EDD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4704 DEAN PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-2536
Mailing Address - Country:US
Mailing Address - Phone:479-927-3007
Mailing Address - Fax:
Practice Address - Street 1:4704 DEAN PL
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-2536
Practice Address - Country:US
Practice Address - Phone:479-927-3007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-18
Last Update Date:2007-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor