Healthcare Provider Details

I. General information

NPI: 1700936275
Provider Name (Legal Business Name): LAURIE L. CALLAN,NURSE PRACITIONER ,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S 14TH ST
CLINTON IA
52732-5435
US

IV. Provider business mailing address

PO BOX 361
CLINTON IA
52733-0361
US

V. Phone/Fax

Practice location:
  • Phone: 563-357-1757
  • Fax:
Mailing address:
  • Phone: 563-242-5316
  • Fax: 563-242-3128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA074701
License Number StateIA

VIII. Authorized Official

Name: MRS. LAURIE L CALLAN
Title or Position: OWNER
Credential: APN,CWOCN
Phone: 563-357-1757