Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 075563 | MO |
NPI | 1194269548 |
---|---|
Provider Name | Carla Calvin |
First Address | Chesterfield, MO 63017-3406 |
Second Address | Chesterfield, MO 63017-3406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2016 |
Last Update Date | 05/12/2016 |