| NPI | 1376662833 |
|---|---|
| Former Name | MIRANDA SUE MCCANN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2011020921) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME160925) |
| 207Q00000X Family Medicine (Licence: IA MD-51019) | |
| 207Q00000X Family Medicine (Licence: OH 35.140812) | |
| 207Q00000X Family Medicine (Licence: TX T9843) | |
| 207Q00000X Family Medicine (Licence: MN 73376) | |
| 207Q00000X Family Medicine (Licence: KS 04-47372) | |
| 207Q00000X Family Medicine (Licence: TN FH0201929) | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2026-05-08 |