Provider Demographics
NPI:1013063551
Name:LAURIE L CALLAHAN, FNP, INC
Entity Type:Organization
Organization Name:LAURIE L CALLAHAN, FNP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, FNP-BC, RNFA
Authorized Official - Phone:541-659-0969
Mailing Address - Street 1:6086 E EVANS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROGUE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97537-9642
Mailing Address - Country:US
Mailing Address - Phone:541-659-0969
Mailing Address - Fax:
Practice Address - Street 1:6086 E EVANS CREEK RD
Practice Address - Street 2:
Practice Address - City:ROGUE RIVER
Practice Address - State:OR
Practice Address - Zip Code:97537-9642
Practice Address - Country:US
Practice Address - Phone:541-659-0969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR095006655163WR0006X
OR200650147NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500618438OtherDMAP
OR500618438OtherDMAP
ORQ73648Medicare UPIN
OR136896Medicare PIN