Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F301300 | NY |
NPI | 1003984204 |
---|---|
Provider Name | Ms. Coleen Balch |
First Address | Clay, NY 13041-9628 |
Second Address | Clay, NY 13041-9628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 15/12/2010 |