Provider Demographics
NPI:1477570455
Name:CALLAHAN, CAROL L (NP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:750 W HAMPDEN AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2165
Mailing Address - Country:US
Mailing Address - Phone:303-341-4730
Mailing Address - Fax:
Practice Address - Street 1:13650 E MISSISSIPPI AVE
Practice Address - Street 2:SUITE 100B
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3561
Practice Address - Country:US
Practice Address - Phone:303-341-4730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO4174363LF0000X
TN13735363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91082056Medicaid
COC-APN4174OtherSTATE NP LICENSE
COQ68870Medicare UPIN