Basic Information
| Provider Information | |||||||||
| NPI: | 1235393844 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HACKER | ||||||||
| FirstName: | CALLENDA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3800 N MESA ST STE A2-343 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799021538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8065359695 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2323 N LAKE DR RM W1736 | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532114508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142986735 | ||||||||
| FaxNumber: | 4142986751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2008 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | N9562 | TX | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 2081P0010X | 53152 | WI | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pediatric Rehabilitation Medicine | 2081P0010X | N9562 | TX | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pediatric Rehabilitation Medicine | 208100000X | 53152 | WI | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.