MEDICARE: TERESA CALLAN

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
1	363LF0000X	Family Nurse Practitioner	AP139566	TX
2	363L00000X	Nurse Practitioner	AP139566	TX

General Provider Information

NPI Number	:	1841760642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA CALLAN

Provider Business Mailing Address
First Line	:	PO BOX 360557
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15251-6557
Country	:	US
Telephone Number	:	915-444-5460
Fax Number	:	915-225-3745

Provider Business Practice Location Address
First Line	:	10090 RUSHING RD STE B
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79924-3803
Country	:	US
Telephone Number	:	915-248-1793
Fax Number	:	915-225-3745

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2018
Last Update Date	:	06/05/2023

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Directions to “ TERESA CALLAN ” Practice Location

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