Provider Demographics
NPI:1922079482
Name:MCCALLUM, LANA (NP)
Entity Type:Individual
Prefix:MS
First Name:LANA
Middle Name:
Last Name:MCCALLUM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 15TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-4500
Mailing Address - Country:US
Mailing Address - Phone:970-378-4170
Mailing Address - Fax:970-378-4171
Practice Address - Street 1:1800 15TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-4500
Practice Address - Country:US
Practice Address - Phone:970-378-4170
Practice Address - Fax:970-378-4171
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO63054363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2554046Medicaid
COC543918Medicare PIN
COS72937Medicare UPIN
CO543918Medicare ID - Type Unspecified