Provider Demographics
NPI:1598990103
Name:CALLAWAY, FREDA D (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:FREDA
Middle Name:D
Last Name:CALLAWAY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10710 CHARTER DR STE 120
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3258
Mailing Address - Country:US
Mailing Address - Phone:410-992-9797
Mailing Address - Fax:410-992-7860
Practice Address - Street 1:10710 CHARTER DR STE 110
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044
Practice Address - Country:US
Practice Address - Phone:410-992-9797
Practice Address - Fax:410-730-0942
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR099368367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered