Provider Demographics
NPI:1669683363
Name:CALLAHAN, WENDY ELGIN (LVN)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:ELGIN
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 SAN LUIS REY DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-1122
Mailing Address - Country:US
Mailing Address - Phone:760-473-4624
Mailing Address - Fax:760-967-5909
Practice Address - Street 1:1707 ELSER LN
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-1814
Practice Address - Country:US
Practice Address - Phone:760-756-4403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN149490164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA91177269A45038Medicare ID - Type UnspecifiedJAMI HOWAARD