Provider Demographics
NPI:1730764994
Name:BRUTON, CALVETTA (CARE GIVER)
Entity type:Individual
Prefix:MRS
First Name:CALVETTA
Middle Name:
Last Name:BRUTON
Suffix:
Gender:F
Credentials:CARE GIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 S RAINBOW BLVD STE 102-559
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-0406
Mailing Address - Country:US
Mailing Address - Phone:702-426-6886
Mailing Address - Fax:
Practice Address - Street 1:4848 RAVEN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-8162
Practice Address - Country:US
Practice Address - Phone:702-426-6886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4100050682Medicaid