Healthcare Provider Details

I. General information

NPI: 1184271777
Provider Name (Legal Business Name): DR. CALLIE COMSTOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 VANDENBERG DR
HANSCOM AFB MA
01731-2104
US

IV. Provider business mailing address

90 VANDENBERG DR
HANSCOM AFB MA
01731-2104
US

V. Phone/Fax

Practice location:
  • Phone: 781-225-6789
  • Fax:
Mailing address:
  • Phone: 781-225-6789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number025334
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.025334
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN2312141
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: