Individual
KRYSTLE CALLAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
111 BEACH DR, WEST ISLIP, NY 11795-4929
(631) 417-8643
Mailing address
195 MASSACHUSETTS AVE, MASSAPEQUA, NY 11758-4218
(516) 737-2093
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F311860-01
NY
Other
Enumeration date
07/10/2024
Last updated
07/10/2024
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