Provider Demographics
NPI:1881563534
Name:MCCANNELLEY, ALICIA S (LPN)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:S
Last Name:MCCANNELLEY
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 1:20291 GLEN RUSS LN
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-2400
Mailing Address - Country:US
Mailing Address - Phone:216-801-1908
Mailing Address - Fax:
Practice Address - Street 1:20291 GLEN RUSS LN
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-2400
Practice Address - Country:US
Practice Address - Phone:216-416-5277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-31
Last Update Date:2025-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.173743.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty