Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Family |
363LF0000X | 50 | Nurse Practitioner | |
Legal Medicine |
173000000X |
| NPI # | 1386883007 |
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| LBN Legal business name | CALLICOAT FAMILY CLINIC | ||||||||
| Authorized official | DONNA CALLICOAT - (NP) | ||||||||
| Entity | Organization | ||||||||
| Organization subpart 1 | No | ||||||||
| Enumeration date | 02/19/2009 | ||||||||
| Last updated | 12/21/2010 - About 15 years ago | ||||||||
| Identifiers |
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