MEDICARE: MRS. REBECCA E BALFANZ MSN, RN, CPNP-PC

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
1	363LP0200X	Pediatric Nurse Practitioner	831310	TX

General Provider Information

NPI Number	:	1316458359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA E BALFANZ MSN, RN, CPNP-PC

Provider Business Mailing Address
First Line	:	890 LARKSPUR LN
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77706-4446
Country	:	US
Telephone Number	:	409-679-9125
Fax Number	:

Provider Business Practice Location Address
First Line	:	3220 CENTRAL MALL DR
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-8037
Country	:	US
Telephone Number	:	409-729-7900
Fax Number	:	409-729-7900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2017
Last Update Date	:	02/14/2018

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