Provider Demographics
NPI:1548709272
Name:CALMA, CAROL (APN)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:CALMA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:CALMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:4605 N ELSTON AVE
Mailing Address - Street 2:3A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-4373
Mailing Address - Country:US
Mailing Address - Phone:773-742-9708
Mailing Address - Fax:
Practice Address - Street 1:4605 N ELSTON AVE
Practice Address - Street 2:3A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-4373
Practice Address - Country:US
Practice Address - Phone:773-742-9708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015201363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner