Healthcare Provider Details

I. General information

NPI: 1386138550
Provider Name (Legal Business Name): CLAUDIA CALLES REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2586 7TH AVE E STE 302
NORTH ST PAUL MN
55109-3090
US

IV. Provider business mailing address

6532 2ND AVE S
RICHFIELD MN
55423-1623
US

V. Phone/Fax

Practice location:
  • Phone: 651-633-7300
  • Fax: 651-633-7301
Mailing address:
  • Phone: 830-776-3460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number2396851
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: