Healthcare Provider Details

I. General information

NPI: 1477573822
Provider Name (Legal Business Name): NANCY T CALLAN PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 CENTRAL STREET STE 116
FOXBORO MA
02035
US

IV. Provider business mailing address

132 CENTRAL ST SUITE 116
FOXBORO MA
02035-2433
US

V. Phone/Fax

Practice location:
  • Phone: 508-543-6306
  • Fax:
Mailing address:
  • Phone: 508-543-6306
  • Fax: 508-543-2976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number142275
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN142275
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: