Healthcare Provider Details

I. General information

NPI: 1578972279
Provider Name (Legal Business Name): CRISTA M CALLAGHAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRISTA M MAGGIO NP

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 HAZARD AVE STE 4
ENFIELD CT
06082-5425
US

IV. Provider business mailing address

52 THERESE DR
SOMERS CT
06071-1005
US

V. Phone/Fax

Practice location:
  • Phone: 860-626-9979
  • Fax: 331-284-6598
Mailing address:
  • Phone: 860-626-9979
  • Fax: 331-284-6598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN2265640
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: