Provider Demographics
NPI:1316214398
Name:CALLAHAN, CAROL (LPN)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 FLETCHER ST.
Mailing Address - Street 2:HORSEHEADS SCHOOL DISTRICT
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-2373
Mailing Address - Country:US
Mailing Address - Phone:607-739-5601
Mailing Address - Fax:607-795-2510
Practice Address - Street 1:401 FLETCHER ST.
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845
Practice Address - Country:US
Practice Address - Phone:607-739-5601
Practice Address - Fax:607-795-2510
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1211161164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse