Provider Demographics
NPI:1548012255
Name:MCCALLA, ELLEN MARY (DNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARY
Last Name:MCCALLA
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 N RILEY AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46201-3715
Mailing Address - Country:US
Mailing Address - Phone:812-584-9105
Mailing Address - Fax:
Practice Address - Street 1:3850 SHORE DR STE 315
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-4693
Practice Address - Country:US
Practice Address - Phone:317-429-0061
Practice Address - Fax:317-222-1953
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28261495A363L00000X
OHRN.402704163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse