Provider Demographics
NPI:1144565433
Name:CALLAHAN, CALLIE M (APRN)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:M
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36123 SCHOOLCRAFT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1216
Mailing Address - Country:US
Mailing Address - Phone:913-660-1616
Mailing Address - Fax:913-660-1664
Practice Address - Street 1:1615 PARKER AVE
Practice Address - Street 2:
Practice Address - City:OSAWATOMIE
Practice Address - State:KS
Practice Address - Zip Code:66064-1703
Practice Address - Country:US
Practice Address - Phone:913-660-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013001553363LA2200X
KS53-75761-021363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
R28A00007Medicare PIN
111023007Medicare PIN
R28000007Medicare PIN