Basic Information
| Provider Information | |||||||||
| NPI: | 1871524652 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCANN | ||||||||
| FirstName: | ALYNE | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HAGGARD | ||||||||
| OtherFirstName: | ALYNE | ||||||||
| OtherMiddleName: | R | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 501 LAPEER AVE | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486071208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897596464 | ||||||||
| FaxNumber: | 9893998233 | ||||||||
| Practice Location | |||||||||
| Address1: | 3884 MONITOR ROAD | ||||||||
| Address2: | BAYSIDE COMMUNITY HEALTH CENTER | ||||||||
| City: | BAY CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487069298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9896712000 | ||||||||
| FaxNumber: | 9896714000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 01/31/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 4704138353 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 381908328325 | 01 | CCM OF MICHIGAN | OTHER | 381908328328 | 01 | CCM OF MICHIGAN | OTHER | 4852297 | 05 | MI | MEDICAID | 1018240 | 01 | MI | MCLAREN HEALTH PLAN | OTHER | 381908328326 | 01 | CCM OF MICHIGAN | OTHER | TYPE 77 | 05 | MI | MEDICAID | 381908328327 | 01 | CCM OF MICHIGAN | OTHER | 153963 | 01 | GREAT LAKES HEALTH | OTHER | 1871524652 | 05 | MI | MEDICAID | 381908328324 | 01 | CCM OF MICHIGAN | OTHER | 500G310570 | 01 | BCBS OF MICHIGAN | OTHER |