=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316214398
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROL CALLAHAN L.P.N.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2011
-----------------------------------------------------
Last Update Date | 11/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 FLETCHER ST.
-----------------------------------------------------
City | HORSEHEADS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-739-5601
-----------------------------------------------------
Fax | 607-795-2510
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 FLETCHER ST. HORSEHEADS SCHOOL DISTRICT
-----------------------------------------------------
City | HORSEHEADS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14845-2373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-739-5601
-----------------------------------------------------
Fax | 607-795-2510
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | 1211161
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------