Healthcare Provider Details

I. General information

NPI: 1649361585
Provider Name (Legal Business Name): JANE JOHNSTON BALKAM PHD, APRN, CPNP,IBCL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 01/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10117 PARKWOOD TER
BETHESDA MD
20814-4035
US

IV. Provider business mailing address

10117 PARKWOOD TER
BETHESDA MD
20814-4035
US

V. Phone/Fax

Practice location:
  • Phone: 301-656-2526
  • Fax: 301-897-8181
Mailing address:
  • Phone: 301-656-2526
  • Fax: 301-897-8181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR062391
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: