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NPI Code Detail

MEDICARE: JACOB BALINKY PMHNP-BC

MEDICARE: JACOB BALINKY PMHNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WP0808XPsychiatric/Mental Health Registered Nurse200542475RNOR
2363LP0808XPsychiatric/Mental Health Nurse Practitioner200750104NPOR

General Provider Information

NPI Number : 1184818080
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB BALINKY PMHNP-BC
Provider Business Mailing Address
First Line : 5516 NE 45TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97218-1422
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3716 NE MLK BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97212-1111
Country : US
Telephone Number : 503-288-8066
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2007
Last Update Date : 11/01/2012

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Directions to “ JACOB BALINKY PMHNP-BC” Practice Location

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