Provider Demographics
NPI:1629349808
Name:KALLWEIT, JUDITH EILEEN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:EILEEN
Last Name:KALLWEIT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1503 PELHAM RD
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9304
Mailing Address - Country:US
Mailing Address - Phone:252-744-2070
Mailing Address - Fax:252-744-2417
Practice Address - Street 1:600 MOYE BLVD
Practice Address - Street 2:LSB 188 MAIL STOP 640
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4300
Practice Address - Country:US
Practice Address - Phone:252-744-2070
Practice Address - Fax:252-744-2417
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC201406364SX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0106XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOccupational Health