Provider Demographics
NPI:1043787112
Name:CALAMIONG, VIVIAN GRACE
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:GRACE
Last Name:CALAMIONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VIVIAN GRACE
Other - Middle Name:DELA CRUZ
Other - Last Name:CALAMIONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:1306 SW 114TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-3511
Mailing Address - Country:US
Mailing Address - Phone:206-388-6488
Mailing Address - Fax:
Practice Address - Street 1:1306 SW 114TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98146-3511
Practice Address - Country:US
Practice Address - Phone:206-388-6488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00056940164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse