Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 28173980A | IN |
Y | 363LN0000X | Nurse Practitioner - Neonatal | 71009291A | IN |
NPI | 1184286791 |
---|---|
Provider Name | Casey Joanne Callahan |
First Address | Indianapolis, IN 46206-1026 |
Second Address | Indianapolis, IN 46202-5109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2019 |
Last Update Date | 01/02/2021 |