MEDICARE: DANA CALLOWAY

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	2019033699	MO

General Provider Information

NPI Number	:	1841848199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA CALLOWAY

Provider Business Mailing Address
First Line	:	220 S WOODBINE RD
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-3447
Country	:	US
Telephone Number	:	816-676-1300
Fax Number	:	816-676-1400

Provider Business Practice Location Address
First Line	:	220 S WOODBINE RD
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-3447
Country	:	US
Telephone Number	:	816-676-1300
Fax Number	:	816-676-1400

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

Provider Enumeration Date	:	08/29/2019
Last Update Date	:	08/29/2019

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Directions to “ DANA CALLOWAY ” Practice Location

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