Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1174080345 |
---|---|
Provider Name | Hannah Callahan |
First Address | Poplar Bluff, MO 63901-8685 |
Second Address | Poplar Bluff, MO 63901-8685 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2019 |
Last Update Date | 25/02/2019 |