Provider Demographics
NPI:1033895461
Name:BALONIS, JAMIE LYNNE (RN)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNNE
Last Name:BALONIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 COPPER LANTERN LN
Mailing Address - Street 2:
Mailing Address - City:CARVER
Mailing Address - State:MA
Mailing Address - Zip Code:02330-1763
Mailing Address - Country:US
Mailing Address - Phone:774-269-1999
Mailing Address - Fax:
Practice Address - Street 1:4 COPPER LANTERN LN
Practice Address - Street 2:
Practice Address - City:CARVER
Practice Address - State:MA
Practice Address - Zip Code:02330-1763
Practice Address - Country:US
Practice Address - Phone:774-269-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN283279163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse