MEDICARE: CALLIE LANDIS CPES

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	374J00000X	Doula		PA

General Provider Information

NPI Number	:	1598277196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALLIE LANDIS CPES

Provider Business Mailing Address
First Line	:	PO BOX 73
Second Line	:
City	:	LAMPETER
State	:	PA
Zip	:	17537-0073
Country	:	US
Telephone Number	:	717-925-0154
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 CREEKWOOD DR
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17602-1367
Country	:	US
Telephone Number	:	717-925-0154
Fax Number	:

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

Provider Enumeration Date	:	11/04/2017
Last Update Date	:	11/04/2017

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