Healthcare Provider Details

I. General information

NPI: 1063665578
Provider Name (Legal Business Name): NANCY MARIE CALLAHAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PLZ
DAYTON OH
45404-1898
US

IV. Provider business mailing address

1 CHILDRENS PLZ
DAYTON OH
45404-1898
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3000
  • Fax: 937-641-5076
Mailing address:
  • Phone: 937-641-3000
  • Fax: 937-641-5076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number184319
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: