Provider Demographics
NPI:1306281373
Name:CALANDRA, MICHELLE KAREN (RN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KAREN
Last Name:CALANDRA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON AFB
Mailing Address - State:SC
Mailing Address - Zip Code:29404-2020
Mailing Address - Country:US
Mailing Address - Phone:843-760-4383
Mailing Address - Fax:843-767-5932
Practice Address - Street 1:1000 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON AFB
Practice Address - State:SC
Practice Address - Zip Code:29404-2020
Practice Address - Country:US
Practice Address - Phone:843-760-4383
Practice Address - Fax:843-767-5932
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR 108847163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool