Provider Demographics
NPI:1942072160
Name:CALKUSIC, SANDRA MILENA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:MILENA
Last Name:CALKUSIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2426 REGATTA LN
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77568-6057
Mailing Address - Country:US
Mailing Address - Phone:281-975-9639
Mailing Address - Fax:
Practice Address - Street 1:600 N KOBAYASHI
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4840
Practice Address - Country:US
Practice Address - Phone:281-724-1864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF10230366363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily