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General NPI Number Information
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NPI Number | 1184407355
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Entity Type | Individual
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Provider Name | CALLIE VAN DYCK PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/14/2023
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 6901 W EDGERTON AVE
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City | GREENFIELD
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State | WI
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Zip | 53220-4420
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Country | US
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Telephone | 507-429-1401
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Fax |
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Provider Business Mailing Address
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Address Line | 6901 W EDGERTON AVE
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City | GREENFIELD
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State | WI
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Zip | 53220-4420
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 10822836
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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