Healthcare Provider Details

I. General information

NPI: 1699761742
Provider Name (Legal Business Name): BRADLEY SCOTT CALLIHAN CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 BUDFIELD ST
JOHNSTOWN PA
15904-3219
US

IV. Provider business mailing address

323 BUDFIELD ST
JOHNSTOWN PA
15904-3219
US

V. Phone/Fax

Practice location:
  • Phone: 814-262-9500
  • Fax: 814-262-7303
Mailing address:
  • Phone: 814-262-9500
  • Fax: 814-262-7303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberVP005659D
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: