Healthcare Provider Details

I. General information

NPI: 1316079494
Provider Name (Legal Business Name): SARAH CALLANAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 10/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 MAIN ST SUITE 101
CHESTER MD
21619-2791
US

IV. Provider business mailing address

PO BOX 12622
BELFAST ME
04915-4017
US

V. Phone/Fax

Practice location:
  • Phone: 410-604-6560
  • Fax:
Mailing address:
  • Phone: 443-481-6577
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR069851
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0000857
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: