Provider Demographics
NPI:1033296561
Name:CALLON, JANET ANN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:ANN
Last Name:CALLON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 775383
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5383
Mailing Address - Country:US
Mailing Address - Phone:812-375-3000
Mailing Address - Fax:812-375-3477
Practice Address - Street 1:625 N PLAZA DR
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-5502
Practice Address - Country:US
Practice Address - Phone:480-983-0065
Practice Address - Fax:480-983-0896
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001951363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200801230Medicaid
INQ57769Medicare UPIN
IN200801230Medicaid
IN232230SSSMedicare UPIN