Healthcare Provider Details

I. General information

NPI: 1053481085
Provider Name (Legal Business Name): PATRICIA CALLAHAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST
PHILADELPHIA PA
19104-4206
US

IV. Provider business mailing address

3400 SPRUCE ST 1 WEST GATES
PHILADELPHIA PA
19104-4206
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-2730
  • Fax: 215-349-5224
Mailing address:
  • Phone: 215-662-2730
  • Fax: 215-349-5224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberUP001577G
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN219155L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: