Provider Demographics
NPI:1033782453
Name:BALCHITIS, KAYLEE NICOLE
Entity Type:Individual
Prefix:MRS
First Name:KAYLEE
Middle Name:NICOLE
Last Name:BALCHITIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-2247
Mailing Address - Country:US
Mailing Address - Phone:262-822-6134
Mailing Address - Fax:
Practice Address - Street 1:2139 RIVIERA DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-2247
Practice Address - Country:US
Practice Address - Phone:262-822-6134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI325560-31163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse