Healthcare Provider Details

I. General information

NPI: 1730108119
Provider Name (Legal Business Name): MARGARET F BALACKI MSN-CRNP/PMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. MARGARET RUTH FOOTE

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 YORK RD SUITE 309
LUTHERVILLE MD
21093-6097
US

IV. Provider business mailing address

803 LATCHMERE CT UNIT 103
ANNAPOLIS MD
21401-8268
US

V. Phone/Fax

Practice location:
  • Phone: 410-825-2281
  • Fax: 410-825-0757
Mailing address:
  • Phone: 410-825-2281
  • Fax: 410-825-0757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR061828
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberR061828
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: