Provider Demographics
NPI:1770650814
Name:MCCANN, SHIRLEY ANN (RNC NP)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:ANN
Last Name:MCCANN
Suffix:
Gender:F
Credentials:RNC NP
Other - Prefix:MS
Other - First Name:SHIRLEY
Other - Middle Name:ANN
Other - Last Name:SKINNER MCCANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNC NP
Mailing Address - Street 1:31 W 155TH ST
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-3556
Mailing Address - Country:US
Mailing Address - Phone:708-596-5177
Mailing Address - Fax:
Practice Address - Street 1:31 W. 155TH ST
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426
Practice Address - Country:US
Practice Address - Phone:708-596-5177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209002822363L00000X, 363LX0001X
IL041147153163W00000X
IL277000622363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3770000603OtherFULL PRACTICE AUTHORITY APRN CONTROLLED SUBSTANCE
IL277000622Medicaid
IL041147153OtherRN
IL209002822OtherLICENSE APN
IL309002318OtherAPN CONTROLLED