Provider Demographics
NPI:1316614795
Name:MCANALLY, SUE MARIE (LPN)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:MARIE
Last Name:MCANALLY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4807
Mailing Address - Country:US
Mailing Address - Phone:651-665-9795
Mailing Address - Fax:651-665-9796
Practice Address - Street 1:856 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4807
Practice Address - Country:US
Practice Address - Phone:651-665-9795
Practice Address - Fax:651-665-9796
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN200347164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse