Provider Demographics
NPI:1235393844
Name:HACKER, CALLENDA A (MD)
Entity Type:Individual
Prefix:
First Name:CALLENDA
Middle Name:A
Last Name:HACKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 N MESA ST STE A2-343
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-1538
Mailing Address - Country:US
Mailing Address - Phone:806-535-9695
Mailing Address - Fax:
Practice Address - Street 1:2323 N LAKE DR RM W1736
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4508
Practice Address - Country:US
Practice Address - Phone:414-298-6735
Practice Address - Fax:414-298-6751
Is Sole Proprietor?:No
Enumeration Date:2008-07-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9562208100000X, 2081P0010X
WI531522081P0010X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine