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General NPI Number Information
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NPI Number | 1366015067
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Entity Type | Individual
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Provider Name | PRIYA SABUMON BALAN RN
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Gender | Female
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Dates
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Enumeration Date | 07/20/2021
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 4112 E WILDWOOD DR
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City | PHOENIX
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State | AZ
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Zip | 85048-8848
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Country | US
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Telephone | 302-241-7082
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Fax |
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Provider Business Mailing Address
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Address Line | 6677 W THUNDERBIRD RD STE I164
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City | GLENDALE
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State | AZ
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Zip | 85306-3762
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Country | US
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Telephone | 623-878-2100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 271815
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | RN214133
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License Number State | AZ
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