Provider Demographics
NPI:1821538646
Name:CALVERT, DEBRA LYNN (LICENSED ELECTROLOGI)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:CALVERT
Suffix:
Gender:F
Credentials:LICENSED ELECTROLOGI
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:LYNN
Other - Last Name:STAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:524 W VARTIKIAN AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-1443
Mailing Address - Country:US
Mailing Address - Phone:559-261-2100
Mailing Address - Fax:
Practice Address - Street 1:524 W VARTIKIAN AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-1443
Practice Address - Country:US
Practice Address - Phone:559-261-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL6591247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other