Healthcare Provider Details

I. General information

NPI: 1770425779
Provider Name (Legal Business Name): IMELDA BALILI MSN, CNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 W THUNDERBIRD RD STE 189
PEORIA AZ
85381-4210
US

IV. Provider business mailing address

24 W CAMELBACK RD STE 445
PHOENIX AZ
85013-2529
US

V. Phone/Fax

Practice location:
  • Phone: 602-830-0699
  • Fax: 602-830-0499
Mailing address:
  • Phone: 602-830-0699
  • Fax: 602-830-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number281714
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: