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General NPI Number Information
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NPI Number | 1538799747
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Entity Type | Individual
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Provider Name | CRAIG F CALLAM APRN, FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 01/16/2020
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Last Update Date | 07/28/2024
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Provider Practice Location Address
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Address Line | 11555 1/2 POTRERO RD
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City | BANNING
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State | CA
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Zip | 92220-6946
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Country | US
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Telephone | 951-849-4761
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Fax | 951-849-4651
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Provider Business Mailing Address
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Address Line | 11980 MOUNT VERNON AVE
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City | GRAND TERRACE
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State | CA
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Zip | 92313-5172
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Country | US
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Telephone | 909-864-1097
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Fax | 512-256-8799
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9365661
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95239375
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11006675
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11006675
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License Number State | FL
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