Provider Demographics
NPI:1720217763
Name:MCCANN, LISA RENEE (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:RENEE
Last Name:MCCANN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 FIELDER CT
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-2107
Mailing Address - Country:US
Mailing Address - Phone:707-693-1810
Mailing Address - Fax:
Practice Address - Street 1:1515 E ALLUVIAL AVE STE 105
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3832
Practice Address - Country:US
Practice Address - Phone:559-325-9287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18732363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily