Provider Demographics
NPI:1124177647
Name:CALLAN, LAURIE LONERGAN (APN,CWOCN)
Entity type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:LONERGAN
Last Name:CALLAN
Suffix:
Gender:F
Credentials:APN,CWOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 361
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52733-0361
Mailing Address - Country:US
Mailing Address - Phone:563-242-5316
Mailing Address - Fax:563-242-3128
Practice Address - Street 1:1300 W 2ND ST
Practice Address - Street 2:
Practice Address - City:ROCK FALLS
Practice Address - State:IL
Practice Address - Zip Code:61071-1005
Practice Address - Country:US
Practice Address - Phone:815-626-2230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000125363LF0000X
IAA074701363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL277000125OtherLICENSE
IAA074701OtherLICENSE
IAF0806016OtherCERTIFICATE APN