Provider Demographics
NPI:1770765489
Name:KALMBACH, MARY ELLEN (APN)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELLEN
Last Name:KALMBACH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 GALLATIN AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-3225
Mailing Address - Country:US
Mailing Address - Phone:615-226-4330
Mailing Address - Fax:615-650-2565
Practice Address - Street 1:610 GALLATIN AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-3225
Practice Address - Country:US
Practice Address - Phone:615-226-4330
Practice Address - Fax:615-650-2565
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7906363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner