Provider Demographics
NPI:1326101858
Name:CALLANS, MELISSA L (CRNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:CALLANS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:L
Other - Last Name:CLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 WALNUT ST
Mailing Address - Street 2:9TH FL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5176
Mailing Address - Country:US
Mailing Address - Phone:215-829-5064
Mailing Address - Fax:215-829-3081
Practice Address - Street 1:800 WALNUT ST
Practice Address - Street 2:9TH FL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5176
Practice Address - Country:US
Practice Address - Phone:215-829-5064
Practice Address - Fax:215-829-3081
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008990363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA165143K3HMedicare PIN