Provider Demographics
NPI:1346721016
Name:EARLIWINE, CALLIE
Entity Type:Individual
Prefix:MS
First Name:CALLIE
Middle Name:
Last Name:EARLIWINE
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 1:214 MIDDLE GRAVE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MOUNDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26041-6009
Mailing Address - Country:US
Mailing Address - Phone:304-843-4400
Mailing Address - Fax:304-843-5095
Practice Address - Street 1:169 SAND HILL RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:WV
Practice Address - Zip Code:26036-3073
Practice Address - Country:US
Practice Address - Phone:304-547-5041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV76201163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool