Provider Demographics
NPI:1063424257
Name:CALLIES, KATHERINE MARGARET (APNP)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:MARGARET
Last Name:CALLIES
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 RIVERSIDE AVE
Mailing Address - Street 2:GATE B BUILDING 1
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-1123
Mailing Address - Country:US
Mailing Address - Phone:715-732-2075
Mailing Address - Fax:
Practice Address - Street 1:3123 SHORE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-4287
Practice Address - Country:US
Practice Address - Phone:715-732-2075
Practice Address - Fax:715-732-2092
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704147228163WW0101X
WI5638-33363LA2200X, 363LW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400121996Medicare Oscar/Certification