Provider Demographics
NPI:1295458156
Name:MCCANN, ROBERT DANIEL JR (RN)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DANIEL
Last Name:MCCANN
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49290 PAUL DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-2485
Mailing Address - Country:US
Mailing Address - Phone:586-994-1676
Mailing Address - Fax:
Practice Address - Street 1:49290 PAUL DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-2485
Practice Address - Country:US
Practice Address - Phone:586-994-1676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704357742163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse