Provider Demographics
NPI:1619248283
Name:AVIS, CALLIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:AVIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 STANLEY ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-6009
Mailing Address - Country:US
Mailing Address - Phone:508-675-1054
Mailing Address - Fax:
Practice Address - Street 1:400 STANLEY ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-6009
Practice Address - Country:US
Practice Address - Phone:508-675-1054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP00280363LF0000X
MARN2275945363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily