Provider Demographics
NPI:1477296754
Name:CALLAHAN, CHRISTINA MARIE
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:CALLAHAN
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:PO BOX 210
Mailing Address - Street 2:46 ELEMENTARY LANE
Mailing Address - City:WOOLRICH
Mailing Address - State:PA
Mailing Address - Zip Code:17779-0210
Mailing Address - Country:US
Mailing Address - Phone:570-769-6207
Mailing Address - Fax:
Practice Address - Street 1:46 ELEMENTARY LANE
Practice Address - Street 2:
Practice Address - City:WOOLRICH
Practice Address - State:PA
Practice Address - Zip Code:17779-1777
Practice Address - Country:US
Practice Address - Phone:570-769-6207
Practice Address - Fax:570-769-6345
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA227120376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Multi-Specialty