Healthcare Provider Details

I. General information

NPI: 1497915177
Provider Name (Legal Business Name): BETH CALLENDER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1573 N CLINE AVE
GRIFFITH IN
46319-1567
US

IV. Provider business mailing address

1214 W ELM PL
GRIFFITH IN
46319-2688
US

V. Phone/Fax

Practice location:
  • Phone: 219-864-2297
  • Fax: 219-864-2649
Mailing address:
  • Phone: 219-922-8584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number71002443A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71002443A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code363LP1700X
TaxonomyPerinatal Nurse Practitioner
License Number71002443A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: