Provider Demographics
NPI:1871524652
Name:MCCANN, ALYNE R (FNP)
Entity type:Individual
Prefix:
First Name:ALYNE
Middle Name:R
Last Name:MCCANN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ALYNE
Other - Middle Name:R
Other - Last Name:HAGGARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:501 LAPEER AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607-1208
Mailing Address - Country:US
Mailing Address - Phone:989-759-6464
Mailing Address - Fax:989-399-8233
Practice Address - Street 1:3884 MONITOR ROAD
Practice Address - Street 2:BAYSIDE COMMUNITY HEALTH CENTER
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-9298
Practice Address - Country:US
Practice Address - Phone:989-671-2000
Practice Address - Fax:989-671-4000
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704138353363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
381908328325OtherCCM OF MICHIGAN
381908328328OtherCCM OF MICHIGAN
MI4852297Medicaid
MI1018240OtherMCLAREN HEALTH PLAN
381908328326OtherCCM OF MICHIGAN
MITYPE 77Medicaid
381908328327OtherCCM OF MICHIGAN
153963OtherGREAT LAKES HEALTH
MI1871524652Medicaid
381908328324OtherCCM OF MICHIGAN
500G310570OtherBCBS OF MICHIGAN
381908328327OtherCCM OF MICHIGAN
S47859Medicare UPIN