Healthcare Provider Details

I. General information

NPI: 1780743195
Provider Name (Legal Business Name): MELVA LYNETTE WILSON-CALVIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22831 S RECKER RD
GILBERT AZ
85297-8936
US

IV. Provider business mailing address

22831 S RECKER RD
GILBERT AZ
85297-8936
US

V. Phone/Fax

Practice location:
  • Phone: 480-279-1071
  • Fax: 480-279-1076
Mailing address:
  • Phone: 480-279-1071
  • Fax: 480-279-1076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberAFC-5336
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: