Provider Demographics
NPI:1538315015
Name:MCCALLUM, COURTNEY ANN (RN)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANN
Last Name:MCCALLUM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11963 SW TUALTIN RD J1037
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-6216
Mailing Address - Country:US
Mailing Address - Phone:503-869-5418
Mailing Address - Fax:
Practice Address - Street 1:11963 SW TUALATIN RD # J1037
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-6216
Practice Address - Country:US
Practice Address - Phone:503-869-5418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200841828RN163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical