Provider Demographics
NPI:1538330477
Name:CALVIN, PATRICIA L (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:CALVIN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27W411 PROVIDENCE LN
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1074
Mailing Address - Country:US
Mailing Address - Phone:312-953-9233
Mailing Address - Fax:630-653-1277
Practice Address - Street 1:27W411 PROVIDENCE LN
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1074
Practice Address - Country:US
Practice Address - Phone:312-953-9233
Practice Address - Fax:630-653-1277
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006968363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209006968OtherADVANCE PRACTICE NURSE