MEDICARE: MS. CATHERINE LOUISE BALKA APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	188294-4405	UT
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	188294-8900	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	188294-4405	OTHER	UT	APRN LICENSE
2	188294-8900	OTHER	UT	APRN CONTROLLED SUBSTANCE

General Provider Information

NPI Number	:	1477597060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CATHERINE LOUISE BALKA APRN

Provider Business Mailing Address
First Line	:	1543 WINWARD DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-7535
Country	:	US
Telephone Number	:	801-582-1565
Fax Number	:	801-584-2544

Provider Business Practice Location Address
First Line	:	1543 WINWARD DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-7535
Country	:	US
Telephone Number	:	801-582-1565
Fax Number	:	801-584-2544

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	07/21/2022

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