Provider Demographics
NPI:1639989981
Name:MCCANN, SARAH GRACE (PA)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:GRACE
Last Name:MCCANN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 INNOVATION DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SLIPPERY ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:16057-2468
Mailing Address - Country:US
Mailing Address - Phone:833-684-1891
Mailing Address - Fax:
Practice Address - Street 1:100 INNOVATION DR STE 101
Practice Address - Street 2:
Practice Address - City:SLIPPERY ROCK
Practice Address - State:PA
Practice Address - Zip Code:16057-2468
Practice Address - Country:US
Practice Address - Phone:833-684-1891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA007143363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant