MEDICARE: PAMELA BALCH MAES N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	NPF4846	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013918200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA BALCH MAES N.P.

Provider Business Mailing Address
First Line	:	3536 MENDOCINO AVE
Second Line	:	STE 200
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-3634
Country	:	US
Telephone Number	:	707-525-6485
Fax Number	:	707-262-5844

Provider Business Practice Location Address
First Line	:	5108 HILL RD E
Second Line	:
City	:	LAKEPORT
State	:	CA
Zip	:	95453-6300
Country	:	US
Telephone Number	:	707-262-1840
Fax Number	:	707-262-5844

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	02/08/2012

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