Healthcare Provider Details

I. General information

NPI: 1255984704
Provider Name (Legal Business Name): CHRISTINE CALLAHAN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 JOSEPH SIEWICK DR STE 203
FAIRFAX VA
22033-1712
US

IV. Provider business mailing address

3309 CANNONGATE RD APT 102
FAIRFAX VA
22031-4809
US

V. Phone/Fax

Practice location:
  • Phone: 703-391-1500
  • Fax:
Mailing address:
  • Phone: 301-875-6345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number0024177655
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: