Provider Demographics
NPI:1700644028
Name:MCCALLUM, WILLENA (PHLEBOTOMIST)
Entity Type:Individual
Prefix:
First Name:WILLENA
Middle Name:
Last Name:MCCALLUM
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 LINDEN AVE STE 180
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432-3058
Mailing Address - Country:US
Mailing Address - Phone:937-301-9356
Mailing Address - Fax:877-552-1617
Practice Address - Street 1:711 CLEVERLY RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-1210
Practice Address - Country:US
Practice Address - Phone:937-301-9356
Practice Address - Fax:877-552-1617
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH060818-OPTC15242246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy