Provider Demographics
NPI:1760464200
Name:KALVIG, JEFFREY J (CRNA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J
Last Name:KALVIG
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 S MAIN
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:IA
Mailing Address - Zip Code:50525
Mailing Address - Country:US
Mailing Address - Phone:515-532-2811
Mailing Address - Fax:515-532-9336
Practice Address - Street 1:1316 S MAIN
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:IA
Practice Address - Zip Code:50525
Practice Address - Country:US
Practice Address - Phone:515-532-2811
Practice Address - Fax:515-532-9336
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA068252367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0600460Medicaid
IA0161422Medicaid
IA0161422Medicaid