MEDICARE: MRS. RAQUEL R CALLAHAN BSN, R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1295144129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RAQUEL R CALLAHAN BSN, R.N.

Provider Business Mailing Address
First Line	:	3700 WOODLAND DR
Second Line	:	SUITE 500
City	:	ANCHORAGE
State	:	AK
Zip	:	99517-2555
Country	:	US
Telephone Number	:	907-644-6050
Fax Number	:	907-644-4438

Provider Business Practice Location Address
First Line	:	3700 WOODLAND DR
Second Line	:	SUITE 500
City	:	ANCHORAGE
State	:	AK
Zip	:	99517-2555
Country	:	US
Telephone Number	:	907-644-6050
Fax Number	:	907-644-4438

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2014
Last Update Date	:	08/05/2014

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