MEDICARE: MARY FRANCESS KALLON RN

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	163W00000X	Registered Nurse	26NR12458400	NJ

General Provider Information

NPI Number	:	1881289668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY FRANCESS KALLON RN

Provider Business Mailing Address
First Line	:	89 ORLANDO DR
Second Line	:
City	:	SICKLERVILLE
State	:	NJ
Zip	:	08081-4492
Country	:	US
Telephone Number	:	732-579-7894
Fax Number	:	856-875-7063

Provider Business Practice Location Address
First Line	:	89 ORLANDO DR
Second Line	:
City	:	SICKLERVILLE
State	:	NJ
Zip	:	08081-4492
Country	:	US
Telephone Number	:	732-579-7894
Fax Number	:	856-875-7063

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

Provider Enumeration Date	:	03/04/2021
Last Update Date	:	03/04/2021

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