Provider Demographics
NPI:1235216433
Name:CALLAHAN, MARY E (RN MSM CRNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:RN MSM CRNP
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Mailing Address - Street 1:340 MONTAGE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1782
Mailing Address - Country:US
Mailing Address - Phone:570-346-3686
Mailing Address - Fax:570-346-5301
Practice Address - Street 1:340 MONTAGE MOUNTAIN ROAD
Practice Address - Street 2:
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18510-1191
Practice Address - Country:US
Practice Address - Phone:570-346-3686
Practice Address - Fax:570-346-5301
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PARN153370L364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA589718Medicare UPIN
PA031498Q9ZMedicare ID - Type Unspecified