Basic Information
| Provider Information | |||||||||
| NPI: | 1790028975 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALLENS | ||||||||
| FirstName: | MARY THERESE | ||||||||
| MiddleName: | ACFALLE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6269 KESTRAL VIEW RD | ||||||||
| Address2: | |||||||||
| City: | TRUSSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351736318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059755595 | ||||||||
| FaxNumber: | 2059340655 | ||||||||
| Practice Location | |||||||||
| Address1: | 176 7FL RM 7301F | ||||||||
| Address2: | 619 19TH ST S | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352497404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059755595 | ||||||||
| FaxNumber: | 2059340655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2013 | ||||||||
| LastUpdateDate: | 02/05/2016 | ||||||||
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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 | 363LF0000X | 1-096719 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.