Provider Demographics
NPI:1275543589
Name:BALADO, MALINDA LIL (APRN BC)
Entity Type:Individual
Prefix:MRS
First Name:MALINDA
Middle Name:LIL
Last Name:BALADO
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14292 FLORIDA BOULEVARD
Mailing Address - Street 2:STEWART FAMILY MEDICINE & AFTER HOURS CLINIC
Mailing Address - City:LIVINGSTON
Mailing Address - State:LA
Mailing Address - Zip Code:70754
Mailing Address - Country:US
Mailing Address - Phone:225-686-1114
Mailing Address - Fax:225-686-1115
Practice Address - Street 1:2101 ROBIN AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5772
Practice Address - Country:US
Practice Address - Phone:985-542-7766
Practice Address - Fax:985-542-1754
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04896363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1584541Medicaid
LA4H928B858Medicare PIN
LA4H928DD58Medicare PIN
Q71599Medicare UPIN
LA1584541Medicaid