Provider Demographics
NPI:1134193113
Name:MCCANN, VINETTA M (NP)
Entity type:Individual
Prefix:MS
First Name:VINETTA
Middle Name:M
Last Name:MCCANN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:VINETTA
Other - Middle Name:M
Other - Last Name:HUSSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:POLLOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28573-0068
Mailing Address - Country:US
Mailing Address - Phone:252-636-4502
Mailing Address - Fax:252-633-2785
Practice Address - Street 1:2604 DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-4238
Practice Address - Country:US
Practice Address - Phone:252-636-4502
Practice Address - Fax:252-633-2785
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5016693363L00000X
MA137806363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110015691AMedicaid
MAP22855Medicare UPIN
MA110015691AMedicaid