Provider Demographics
NPI:1144653353
Name:CALLAHAN, BRENDA A (ARNP-BC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:A
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 FRANKLIN ST.
Mailing Address - Street 2:UNIT 305
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:410-703-8211
Mailing Address - Fax:
Practice Address - Street 1:66 FRANKLIN ST
Practice Address - Street 2:UNIT 305
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2748
Practice Address - Country:US
Practice Address - Phone:410-703-8211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR071885363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner