BALANCE THE BRAIN PROFESSIONAL CORPORATION NPI 1073270666

NPI Information

NPI: 1073270666
Provider Name: BALANCE THE BRAIN PROFESSIONAL CORPORATION
Classification: Nurse Practitioner - 363LW0102X
Entity Type: Organization

Specialization: Women's Health

Address:
3772 N MOUNTAINOAK DR
EDEN, UT
ZIP 84310
Phone: (419) 559-5904
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BALANCE THE BRAIN PROFESSIONAL CORPORATION is a women's health nurse practitioner in Eden, UT. BALANCE THE BRAIN PROFESSIONAL CORPORATION NPI is 1073270666. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

3772 N MOUNTAINOAK DR
EDEN, UT
ZIP 84310
Phone: (419) 559-5904

The provider's authorized official is Kelli Kemenah Mauric .
The authorized official title is Owner/ President and has the following contact phone number (419) 559-5904.

The enumeration date for this NPI number is 11/18/2021 and was last updated on 11/18/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LW0102X	Nurse Practitioner	Women's Health			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	363LW0102X	OTHER	OHIO	PRIMARY TAXONOMY
2	I20180403001591	OTHER		PECOS ENROLLMENT ID
3	NP-07962	OTHER	OHIO	BON NP LICENSURE
4	363LW0102X	OTHER	UTAH	SECONDARY TAXONOMY
5	10115460-4405	OTHER	UTAH	NP LICENSURE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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