Provider Demographics
NPI:1891371944
Name:MCCANN, JENNI LOU (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNI
Middle Name:LOU
Last Name:MCCANN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 DODGE ST
Mailing Address - Street 2:STE D5
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
Practice Address - Street 2:STE D5
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:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG162931363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health