Provider Demographics
NPI:1780743195
Name:WILSON-CALVIN, MELVA LYNETTE (RN)
Entity type:Individual
Prefix:MRS
First Name:MELVA
Middle Name:LYNETTE
Last Name:WILSON-CALVIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22831 S RECKER RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-8936
Mailing Address - Country:US
Mailing Address - Phone:480-279-1071
Mailing Address - Fax:480-279-1076
Practice Address - Street 1:22831 S RECKER RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-8936
Practice Address - Country:US
Practice Address - Phone:480-279-1071
Practice Address - Fax:480-279-1076
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAFC-5336311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ482448OtherAHCCCS ID