Provider Demographics
NPI:1487029591
Name:CALVIN, LAMURIEL
Entity Type:Individual
Prefix:
First Name:LAMURIEL
Middle Name:
Last Name:CALVIN
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 1:195 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-3037
Mailing Address - Country:US
Mailing Address - Phone:248-818-4216
Mailing Address - Fax:
Practice Address - Street 1:195 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-3037
Practice Address - Country:US
Practice Address - Phone:248-818-4216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI54239862132700000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No132700000XDietary & Nutritional Service ProvidersDietary Manager