Provider Demographics
NPI:1033720487
Name:BALMACEDA, DANAH JAGUETA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DANAH
Middle Name:JAGUETA
Last Name:BALMACEDA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:DANAH
Other - Middle Name:J
Other - Last Name:BALMACEDA-LEESON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MARRIED NAME
Mailing Address - Street 1:24430 STONE SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:DULLES
Mailing Address - State:VA
Mailing Address - Zip Code:20166-2267
Mailing Address - Country:US
Mailing Address - Phone:571-349-5330
Mailing Address - Fax:
Practice Address - Street 1:24430 STONE SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:DULLES
Practice Address - State:VA
Practice Address - Zip Code:20166-2267
Practice Address - Country:US
Practice Address - Phone:571-439-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179828363LA2100X, 363LA2200X, 363LG0600X, 363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology