Basic Information
| Provider Information | |||||||||
| NPI: | 1851489793 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | CALLENDER | ||||||||
| FirstName: | EALENA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9007 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229069007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4342951000 | ||||||||
| FaxNumber: | 4349724266 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 SAINT FRANCIS AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | SHAKOPEE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553793384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524283535 | ||||||||
| FaxNumber: | 9524283599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 06/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 55871 | MN | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | D0072598 | MD | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 60147 | AZ | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 0101240053 | VA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1851489793 | 05 | VA | MEDICAID |