Mary E. Callahan, RN MSM CRNP

Key facts

NPI

1235216433

Entity type

Individual (NPI type 1)

Primary specialty

Psychiatric/Mental Health Clinical Nurse Specialist 364SP0808X

License

RN153370L (PA)

Practice address

340 Montage Mountain Road
Moosic, PA 18510-1191

Phone

(570) 346-3686

Fax

(570) 346-5301

NPI assigned

Nov 1, 2006

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Certified Nurse Specialist, Certified Registered Nurse, Registered Nurse

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 13, 2008.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1218585600000",
    "number": "1235216433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 MONTAGE MOUNTAIN RD",
            "city": "MOOSIC",
            "state": "PA",
            "postal_code": "185071782",
            "telephone_number": "570-346-3686",
            "fax_number": "570-346-5301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 MONTAGE MOUNTAIN ROAD",
            "city": "MOOSIC",
            "state": "PA",
            "postal_code": "185101191",
            "telephone_number": "570-346-3686",
            "fax_number": "570-346-5301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CALLAHAN",
        "first_name": "MARY",
        "middle_name": "E.",
        "name_prefix": "Ms.",
        "credential": "RN MSM CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2008-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SP0808X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": "PA",
            "license": "RN153370L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Moosic, PA · Psychiatric/Mental Health Clinical Nurse Specialist in Pennsylvania