Provider Demographics
NPI:1477573822
Name:CALLAN, NANCY T (PNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:T
Last Name:CALLAN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 CENTRAL ST
Mailing Address - Street 2:SUITE 116
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-2433
Mailing Address - Country:US
Mailing Address - Phone:508-543-6306
Mailing Address - Fax:508-543-2976
Practice Address - Street 1:132 CENTRAL STREET
Practice Address - Street 2:STE 116
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035
Practice Address - Country:US
Practice Address - Phone:508-543-6306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA142275208000000X
MARN142275363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP9845OtherBLUE CROSS BLUE SHIELD