Basic Information
| Provider Information | |||||||||
| NPI: | 1710185079 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCANLESS | ||||||||
| FirstName: | LISE | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 380 TERN DR APT 3 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341123922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574575100 | ||||||||
| FaxNumber: | 7578197762 | ||||||||
| Practice Location | |||||||||
| Address1: | 8831 IMMOKALEE RD | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341203914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574575100 | ||||||||
| FaxNumber: | 7578197762 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2007 | ||||||||
| LastUpdateDate: | 07/01/2016 | ||||||||
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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 | 363LF0000X | 9876 | VI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 0024118550 | VA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | ARNP9436627 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.