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NPI Code Detail

MEDICARE: HOLLY BALSBAUGH N.P.

MEDICARE: HOLLY BALSBAUGH N.P.
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
1363LF0000XFamily Nurse Practitioner200650084NPOR

General Provider Information

NPI Number : 1710082532
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY BALSBAUGH N.P.
Provider Business Mailing Address
First Line : 875 NE SIMPSON ST
Second Line :
City : PORTLAND
State : OR
Zip : 97211-3748
Country : US
Telephone Number : 503-234-3172
Fax Number :
Provider Business Practice Location Address
First Line : 51377 SW OLD PORTLAND RD STE C
Second Line :
City : SCAPPOOSE
State : OR
Zip : 97056-4023
Country : US
Telephone Number : 503-543-3181
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2006
Last Update Date : 01/14/2010

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Directions to “ HOLLY BALSBAUGH N.P.” Practice Location

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