Provider Demographics
NPI:1609277490
Name:CALVERT, CAROLINE COLGROVE (NP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:COLGROVE
Last Name:CALVERT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:COLGROVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:BIOBALANCE HEALTH 10800 OLIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-1675
Mailing Address - Country:US
Mailing Address - Phone:260-432-4400
Mailing Address - Fax:260-969-6898
Practice Address - Street 1:BIOBALANCE HEALTH 10800 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-993-0963
Practice Address - Fax:260-969-6898
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005165A363L00000X
MO2017004980363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201268300Medicaid
IN259990007Medicare PIN