Healthcare Provider Details

I. General information

NPI: 1144692021
Provider Name (Legal Business Name): CALLAN MARCUS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 95TH ST SUITE B
NAPERVILLE IL
60564-8459
US

IV. Provider business mailing address

1449 N ASHLAND AVE APT 3R
CHICAGO IL
60622-2269
US

V. Phone/Fax

Practice location:
  • Phone: 630-646-6593
  • Fax:
Mailing address:
  • Phone: 913-481-4201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0993388-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209013352
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: