Provider Demographics
NPI:1700936275
Name:LAURIE L. CALLAN,NURSE PRACITIONER ,LLC
Entity Type:Organization
Organization Name:LAURIE L. CALLAN,NURSE PRACITIONER ,LLC
Other - Org Name:LAURIE L. CALLAN,NURSE PRACITIONER ,LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CALLAN
Authorized Official - Suffix:
Authorized Official - Credentials:APN,CWOCN
Authorized Official - Phone:563-357-1757
Mailing Address - Street 1:PO BOX 361
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52733-0361
Mailing Address - Country:US
Mailing Address - Phone:563-242-5316
Mailing Address - Fax:563-242-3128
Practice Address - Street 1:250 S 14TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5435
Practice Address - Country:US
Practice Address - Phone:563-357-1757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA074701363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA074701OtherLICENSE
IAF0806016OtherCERTIFICATE
IAF0806016OtherCERTIFICATE