Provider Demographics
NPI:1679227268
Name:CALVERT, NICOLE MARIE (ATC/LAT, CSCS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:CALVERT
Suffix:
Gender:F
Credentials:ATC/LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:850 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-8401
Mailing Address - Country:US
Mailing Address - Phone:309-743-2070
Mailing Address - Fax:
Practice Address - Street 1:2109 CEDARWOOD DR STE 100
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-2670
Practice Address - Country:US
Practice Address - Phone:563-288-6787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0009442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
200938505OtherCERTIFIED STRENGTH AND CONDITIONING SPECIALIST (NSCA)
IA000944OtherSTATE OF IOWA DEPT OF PUBLIC HEALTH
2000001771OtherBOARD OF CERTIFICATION FOR THE ATHLETIC TRAINER