Basic Information
| Provider Information | |||||||||
| NPI: | 1396300786 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALEY | ||||||||
| FirstName: | JOANN | ||||||||
| MiddleName: | OLAVA | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 30388 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852750388 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808303902 | ||||||||
| FaxNumber: | 4808303901 | ||||||||
| Practice Location | |||||||||
| Address1: | 4555 E INVERNESS AVE STE 112 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852064630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808303900 | ||||||||
| FaxNumber: | 4808303901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2019 | ||||||||
| LastUpdateDate: | 10/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | RN133413 | AZ | N | Nursing Service Providers | Registered Nurse | General Practice | 363LF0000X | 225910 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 225910 | 01 | AZ | AZ LIC | OTHER | 520875 | 05 | AZ | MEDICAID |