1679378822 NPI number — SANDRA MARNITA MCCANN BSN, RN, CCM

Table of content: SANDRA MARNITA MCCANN BSN, RN, CCM (NPI 1679378822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679378822 NPI number — SANDRA MARNITA MCCANN BSN, RN, CCM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCANN
Provider First Name:
SANDRA
Provider Middle Name:
MARNITA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BSN, RN, CCM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679378822
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
703 MILFORD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMPTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23661-1141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-880-4294
Provider Business Mailing Address Fax Number:
757-764-0968

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 NEALY AVE
Provider Second Line Business Practice Location Address:
MEDICAL CASE MANAGEMENT -SGHM
Provider Business Practice Location Address City Name:
HAMPTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23665-2080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-225-6732
Provider Business Practice Location Address Fax Number:
757-764-0968
Provider Enumeration Date:
02/13/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WC0400X , with the licence number:  604739 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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