Basic Information
| Provider Information | |||||||||
| NPI: | 1255641809 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALLINAN | ||||||||
| FirstName: | CELESTE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1520 VIRGINIA RANCH RD | ||||||||
| Address2: | |||||||||
| City: | GARDNERVILLE | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894105731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757821500 | ||||||||
| FaxNumber: | 7757821513 | ||||||||
| Practice Location | |||||||||
| Address1: | 1516 VIRGINIA RANCH RD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | GARDNERVILLE | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894105794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757833020 | ||||||||
| FaxNumber: | 7757833021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2010 | ||||||||
| LastUpdateDate: | 01/21/2013 | ||||||||
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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 | 363A00000X | PA1232 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | PA1232 | 01 | NV | LICENSE NUMBER | OTHER |