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NPI Code Detail

MEDICARE: MS. PENELOPE FAY CALLAWAY FNP-C

MEDICARE: MS. PENELOPE FAY CALLAWAY FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner71002646AIN

General Provider Information

NPI Number : 1487813085
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PENELOPE FAY CALLAWAY FNP-C
Provider Business Mailing Address
First Line : 1214 E NATIONAL AVE STE 100
Second Line :
City : BRAZIL
State : IN
Zip : 47834-2700
Country : US
Telephone Number : 812-442-2100
Fax Number :
Provider Business Practice Location Address
First Line : 1214 E NATIONAL AVE STE 100
Second Line :
City : BRAZIL
State : IN
Zip : 47834-2700
Country : US
Telephone Number : 812-442-2100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2008
Last Update Date : 06/09/2008

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Directions to “ MS. PENELOPE FAY CALLAWAY FNP-C” Practice Location

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