Provider Demographics
NPI:1275188104
Name:MCCANN, MEGHAN LAUREL (APRN)
Entity Type:Individual
Prefix:MS
First Name:MEGHAN
Middle Name:LAUREL
Last Name:MCCANN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 E PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CT
Mailing Address - Zip Code:06878-1528
Mailing Address - Country:US
Mailing Address - Phone:203-637-0662
Mailing Address - Fax:
Practice Address - Street 1:645 POST RD E
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4551
Practice Address - Country:US
Practice Address - Phone:203-557-6334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8123363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner