Provider Demographics
NPI:1215131156
Name:CALLAHAN, ERIN (ANP, RN)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:ANP, RN
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:BALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP, RN
Mailing Address - Street 1:4201 TUDOR CENTRE DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5904
Mailing Address - Country:US
Mailing Address - Phone:907-729-8624
Mailing Address - Fax:907-729-8607
Practice Address - Street 1:4320 DIPLOMACY DR
Practice Address - Street 2:SUITE 1500
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5925
Practice Address - Country:US
Practice Address - Phone:907-729-8624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK17357163W00000X
AK961363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP0961Medicaid
AKNP0961Medicaid
AK8EE754Medicare PIN
AK8EL758Medicare PIN
AK8EL757Medicare PIN
AK8EL754Medicare PIN
AK8EE753Medicare PIN
AK8EL759Medicare PIN
AK8EL756Medicare PIN