MEDICARE: MRS. LISA MICHELLE CALLAHAN RN, MSN, CPNP-PC

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	363LP0200X	Pediatric Nurse Practitioner	94000382	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649261132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA MICHELLE CALLAHAN RN, MSN, CPNP-PC

Provider Business Mailing Address
First Line	:	1601 NE 6TH ST
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-1035
Country	:	US
Telephone Number	:	541-472-0021
Fax Number	:	541-476-4003

Provider Business Practice Location Address
First Line	:	1601 NE 6TH ST
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-1035
Country	:	US
Telephone Number	:	541-472-0021
Fax Number	:	541-476-4003

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	10/12/2016

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Directions to “ MRS. LISA MICHELLE CALLAHAN RN, MSN, CPNP-PC” Practice Location

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