Provider Demographics
NPI:1083731905
Name:CALLAN, NOREEN DOROTHY (NP)
Entity Type:Individual
Prefix:MRS
First Name:NOREEN
Middle Name:DOROTHY
Last Name:CALLAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 LT JOHN OLSEN LN
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-2511
Mailing Address - Country:US
Mailing Address - Phone:631-584-5277
Mailing Address - Fax:
Practice Address - Street 1:283 COMMACK RD STE 300
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3400
Practice Address - Country:US
Practice Address - Phone:631-462-2980
Practice Address - Fax:631-462-2982
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY380482363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner