Basic Information
| Provider Information | |||||||||
| NPI: | 1427539949 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALHOUN | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | ROBERTS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ROBERTS | ||||||||
| OtherFirstName: | JESSICA | ||||||||
| OtherMiddleName: | MARY | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | RN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1810 6TH AVE W | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981192940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583614213 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | MCCLURE MIDDLE SCHOOL | ||||||||
| Address2: | 1915 1ST AVE W | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062521900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2018 | ||||||||
| LastUpdateDate: | 08/23/2018 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | 60794572 | WA | Y | Nursing Service Providers | Registered Nurse | General Practice |
No ID Information.