Provider Demographics
NPI:1679849269
Name:MCCANN QUALLI, ANNE MARIA (CRNP, DNP)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIA
Last Name:MCCANN QUALLI
Suffix:
Gender:F
Credentials:CRNP, DNP
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MARIA
Other - Last Name:MCCANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:1 FEDERAL ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:848-288-6935
Mailing Address - Fax:732-790-0107
Practice Address - Street 1:175 ROUTE 130 S
Practice Address - Street 2:
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-3376
Practice Address - Country:US
Practice Address - Phone:856-536-1640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00379900363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0304930Medicaid
NJ0304930Medicaid
PA243509EZPMedicare PIN