Provider Demographics
NPI:1245739457
Name:CALLIHAN, HEATHER S
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:S
Last Name:CALLIHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 OLD VANDER RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28312
Mailing Address - Country:US
Mailing Address - Phone:910-929-5328
Mailing Address - Fax:
Practice Address - Street 1:415 OLD VANDER RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28312
Practice Address - Country:US
Practice Address - Phone:910-929-5328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-03
Last Update Date:2018-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health