1821538646 NPI number — DEBRA LYNN CALVERT LICENSED ELECTROLOGI

Table of content: DEBRA LYNN CALVERT LICENSED ELECTROLOGI (NPI 1821538646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821538646 NPI number — DEBRA LYNN CALVERT LICENSED ELECTROLOGI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALVERT
Provider First Name:
DEBRA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICENSED ELECTROLOGI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STAPP
Provider Other First Name:
DEBRA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821538646
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
524 W VARTIKIAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93704-1443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-261-2100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
524 W VARTIKIAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93704-1443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-261-2100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 247200000X , with the licence number:  L6591 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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