Lisette Diaz Callahan, RN
Individual provider Active NPI Registered Nurse · Ridge, NY
NPI 1710321997 · NPPES record last updated Apr 18, 2013
Key facts
- NPI
- 1710321997
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 659504 (NY)
- Practice address
- 58 Marc Dr
Ridge, NY 11961-2139 - Phone
- (631) 775-6301
- NPI assigned
- Apr 18, 2013
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 659504 | NY | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 659504 | NY | Yes |
Addresses
Primary practice location
58 Marc Dr
Ridge, NY 11961-2139
Mailing address
58 Marc Dr
Ridge, NY 11961-2139
Phone (631) 775-6301
Other providers in Ridge, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 18, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.