Provider Demographics
NPI:1437346707
Name:MCCALL, MARLA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:MCCALL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 BLUE RAVINE RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-4756
Mailing Address - Country:US
Mailing Address - Phone:916-608-0714
Mailing Address - Fax:916-608-0717
Practice Address - Street 1:970 RESERVE DR
Practice Address - Street 2:SUITE 205
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-1376
Practice Address - Country:US
Practice Address - Phone:916-780-1070
Practice Address - Fax:916-780-1199
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAP2860363LP0808X
CANP 17787363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health