Provider Demographics
NPI:1942870266
Name:CALLOWAY, PATRICIA LABRIE (RN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LABRIE
Last Name:CALLOWAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22530 3RD ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-2932
Mailing Address - Country:US
Mailing Address - Phone:510-393-9473
Mailing Address - Fax:
Practice Address - Street 1:1100 SAN LEANDRO BLVD
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-1595
Practice Address - Country:US
Practice Address - Phone:510-589-0821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55701163WC1500X
CA321589163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health