Provider Demographics
NPI:1881602241
Name:MCCALLEY, PATRICIA ANN (CNM)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:MCCALLEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SHADY LANE
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:PA
Mailing Address - Zip Code:19046-4263
Mailing Address - Country:US
Mailing Address - Phone:215-742-9550
Mailing Address - Fax:215-742-8044
Practice Address - Street 1:16 SHADY LN
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:PA
Practice Address - Zip Code:19046-4263
Practice Address - Country:US
Practice Address - Phone:215-742-9550
Practice Address - Fax:215-742-8044
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW008188L176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0104905101Medicaid
PA0104905101Medicaid
PA146622Medicare ID - Type Unspecified