MEDICARE: MRS. CONCEPCION MUNGCAL BALATBAT R.N.

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	163WC1500X	Community Health Registered Nurse	0001162249	VA

General Provider Information

NPI Number	:	1760555627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CONCEPCION MUNGCAL BALATBAT R.N.

Provider Business Mailing Address
First Line	:	8531 HOOES RD
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22153-1709
Country	:	US
Telephone Number	:	703-644-0916
Fax Number	:

Provider Business Practice Location Address
First Line	:	2605 BEACON HILL RD
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-1611
Country	:	US
Telephone Number	:	703-660-6440
Fax Number	:	703-660-8947

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	07/08/2007

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