Provider Demographics
NPI:1023481744
Name:CALVARIO, MICHELLE AUDREY (CNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:AUDREY
Last Name:CALVARIO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E SUPERIOR ST STE 5-2322
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2914
Mailing Address - Country:US
Mailing Address - Phone:312-926-3411
Mailing Address - Fax:312-926-8430
Practice Address - Street 1:250 E SUPERIOR ST STE 5-2322
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2914
Practice Address - Country:US
Practice Address - Phone:312-926-3411
Practice Address - Fax:312-926-8430
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.013484363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care