Healthcare Provider Details

I. General information

NPI: 1659965804
Provider Name (Legal Business Name): HOLLIE AMBER BALAZS APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 N DIVISION ST STE 4D5E
MORRIS IL
60450-3100
US

IV. Provider business mailing address

1715 N DIVISION ST STE 4D5E
MORRIS IL
60450-3100
US

V. Phone/Fax

Practice location:
  • Phone: 815-431-3410
  • Fax: 815-431-3411
Mailing address:
  • Phone: 815-431-3410
  • Fax: 815-431-3411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277004629
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: