Provider Demographics
NPI:1619107364
Name:MCCANNA, LYNETTE N (NP-C)
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:N
Last Name:MCCANNA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 N 3RD AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1511
Mailing Address - Country:US
Mailing Address - Phone:208-265-2221
Mailing Address - Fax:208-265-2229
Practice Address - Street 1:423 N 3RD AVE STE 210
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1511
Practice Address - Country:US
Practice Address - Phone:208-265-2221
Practice Address - Fax:208-265-2229
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60102358363LF0000X
ID78851363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8884165Medicare PIN
WA0946290001Medicare NSC