Provider Demographics
NPI:1114283470
Name:CALLAHAN, DANICE LEE (LPN)
Entity Type:Individual
Prefix:
First Name:DANICE
Middle Name:LEE
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:DANICE
Other - Middle Name:LEE
Other - Last Name:WINDHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5712 TROY VILLA BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-2648
Mailing Address - Country:US
Mailing Address - Phone:937-212-6470
Mailing Address - Fax:
Practice Address - Street 1:5712 TROY VILLA BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-2648
Practice Address - Country:US
Practice Address - Phone:937-212-6470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN137175-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse