Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 201272 | LA |
Y | 207VX0000X | Obstetrician | 201272 | LA |
NPI | 1083816854 |
---|---|
Provider Name | Jennifer R Mccann |
First Address | Deridder, LA 70634-4863 |
Second Address | Deridder, LA 70634-4863 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2007 |
Last Update Date | 12/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1093271 | (05) | LA |
201988701 | (05) | TX |