Healthcare Provider Details

I. General information

NPI: 1407458599
Provider Name (Legal Business Name): CALLIE PITMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 14TH ST
SACRAMENTO CA
95814-1502
US

IV. Provider business mailing address

622 14TH ST
SACRAMENTO CA
95814-1502
US

V. Phone/Fax

Practice location:
  • Phone: 850-496-0968
  • Fax:
Mailing address:
  • Phone: 850-496-0968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number191385
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95107079
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95107079
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: