Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 0024179828 | VA |
NPI | 1033720487 |
---|---|
Provider Name | Danah Balmaceda |
First Address | Dulles, VA 20166-2267 |
Second Address | Dulles, VA 20166-2267 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2020 |
Last Update Date | 22/09/2020 |