Individual
JACK CALVERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
401 ANDERSON RD, SELAH, WA 98942-9478
(509) 698-3318
Mailing address
401 ANDERSON RD, SELAH, WA 98942-9478
(509) 698-3318
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
AP30002093
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP30002093
STATE OF WA ARNP LICENSE
WA
Enumeration date
12/05/2006
Last updated
07/08/2007
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