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General NPI Number Information
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NPI Number | 1013063551
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Entity Type | Organization
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Legal Business Name | LAURIE L CALLAHAN, FNP, INC
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 10/29/2018
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Provider Practice Location Address
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Address Line | 6086 E EVANS CREEK RD
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City | ROGUE RIVER
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State | OR
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Zip | 97537-9642
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Country | US
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Telephone | 541-659-0969
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Fax |
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Provider Business Mailing Address
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Address Line | 6086 E EVANS CREEK RD
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City | ROGUE RIVER
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State | OR
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Zip | 97537-9642
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Country | US
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Telephone | 541-659-0969
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LAURIE LEIGH CALLAHAN
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Credential | MSN, FNP-BC, RNFA
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Telephone | 541-659-0969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 200650147NP
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | 095006655
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License Number State | OR
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