Provider Demographics
NPI:1831756501
Name:MCCALLA, ELLIE NAN (PA-C)
Entity type:Individual
Prefix:
First Name:ELLIE
Middle Name:NAN
Last Name:MCCALLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1126
Mailing Address - Country:US
Mailing Address - Phone:734-646-5180
Mailing Address - Fax:
Practice Address - Street 1:350 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1126
Practice Address - Country:US
Practice Address - Phone:734-646-5180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant