Provider Demographics
NPI:1720727126
Name:CALLOWAY, NICHEL
Entity Type:Individual
Prefix:DR
First Name:NICHEL
Middle Name:
Last Name:CALLOWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 ARDMORE AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-5315
Mailing Address - Country:US
Mailing Address - Phone:908-266-3851
Mailing Address - Fax:
Practice Address - Street 1:221 ARDMORE AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08757-5315
Practice Address - Country:US
Practice Address - Phone:908-266-3851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
Provider Identifiers
StateIdentifier IDID TypeIssuer
306785610OtherREGISTRATION ID