MEDICARE: EMILY BALKO

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	0024174746	VA

General Provider Information

NPI Number	:	1255867081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY BALKO

Provider Business Mailing Address
First Line	:	250 K ST NE
Second Line	:	APARTMENT 504
City	:	WASHINGTON
State	:	DC
Zip	:	20002-3381
Country	:	US
Telephone Number	:	724-972-2399
Fax Number	:

Provider Business Practice Location Address
First Line	:	2439 N HARRISON ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22207-1611
Country	:	US
Telephone Number	:	571-395-9912
Fax Number	:

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

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	05/11/2017

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