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NPI Code Detail

MEDICARE: PRESTON BALUT STNA

MEDICARE:   PRESTON  BALUT  STNA
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
1376K00000XNurse's Aide401271150711OH

General Provider Information

NPI Number : 1679854699
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRESTON BALUT STNA
Provider Business Mailing Address
First Line : 1524 DREXEL AVE NW
Second Line :
City : WARREN
State : OH
Zip : 44485-2116
Country : US
Telephone Number : 330-219-4688
Fax Number :
Provider Business Practice Location Address
First Line : 1524 DREXEL AVE NW
Second Line :
City : WARREN
State : OH
Zip : 44485-2116
Country : US
Telephone Number : 330-219-4688
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2011
Last Update Date : 09/03/2011

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Directions to “ PRESTON BALUT STNA” Practice Location

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