MEDICARE: LAURA BALMER CRNP

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	363LA2200X	Adult Health Nurse Practitioner	303540-1	NY
2	363LA2200X	Adult Health Nurse Practitioner	SP013789	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497723894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA BALMER CRNP

Provider Business Mailing Address
First Line	:	1201 GRAMPIAN BLVD
Second Line	:	SUITE 1K
City	:	WILLIAMSPORT
State	:	PA
Zip	:	17701-1900
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 MEADE ST
Second Line	:	SUITE L3
City	:	WELLSBORO
State	:	PA
Zip	:	16901-1813
Country	:	US
Telephone Number	:	570-723-2855
Fax Number	:	570-723-2877

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	05/08/2014

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