Provider Demographics
NPI:1043735053
Name:CALDERON, KETURA LYNN
Entity Type:Individual
Prefix:
First Name:KETURA
Middle Name:LYNN
Last Name:CALDERON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 WORTH DR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-6326
Mailing Address - Country:US
Mailing Address - Phone:307-433-4041
Mailing Address - Fax:
Practice Address - Street 1:905 WORTH DR
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-6326
Practice Address - Country:US
Practice Address - Phone:307-433-4041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty