Provider Demographics
NPI:1770667008
Name:MCPHERSON, ANN L (LPN)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:L
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4718 CARRIE MARIE CT APT 2
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-6619
Mailing Address - Country:US
Mailing Address - Phone:989-714-6446
Mailing Address - Fax:
Practice Address - Street 1:2335 S LAKESIDE DR APT 1
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-1319
Practice Address - Country:US
Practice Address - Phone:989-790-3337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703076962164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4500033OtherPROVIDER TYPE 10