Provider Demographics
NPI:1871093807
Name:CALVIN, LATRESHA D (LVN)
Entity type:Individual
Prefix:
First Name:LATRESHA
Middle Name:D
Last Name:CALVIN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 WHITSON WAY
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-1973
Mailing Address - Country:US
Mailing Address - Phone:469-693-9609
Mailing Address - Fax:
Practice Address - Street 1:2420 WHITSON WAY
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-1973
Practice Address - Country:US
Practice Address - Phone:469-693-9609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX311071164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse