Individual
MICAH ANDREW MCCANNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2485 HEMBY LN, SUITE A, GREENVILLE, NC 27834
(252) 752-2140
(888) 787-2249
Mailing address
2485 HEMBY LN, SUITE A, GREENVILLE, NC 27834-3701
(252) 752-2140
(888) 787-2249
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
245932
NC
367500000X
Certified Registered Nurse Anesthetist
0024175283
VA
367500000X
Certified Registered Nurse Anesthetist
106615
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
5220
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1548656564
TRICARE
NC
05
—
1548656564
—
NC
01
—
P01527756
RAILROAD MEDICARE
NC
Enumeration date
04/07/2015
Last updated
06/24/2021
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