Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | 35.083195 | OH |
Y | 2084N0402X | Child Neurologist | E-1267 | AR |
NPI | 1124148028 |
---|---|
Provider Name | Tonya M Balmakund |
First Address | Lowell, AR 72745-8360 |
Second Address | Lowell, AR 72745-8360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 19/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
169668001 | (05) | AR |