Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 110782 | NE |
NPI | 1124279211 |
---|---|
Provider Name | Melissa Balhorn |
First Address | Omaha, NE 68164-8117 |
Second Address | Omaha, NE 68124-2319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2008 |
Last Update Date | 03/02/2009 |