Provider Demographics
NPI:1336698901
Name:BALOCH, AMINA (APN)
Entity Type:Individual
Prefix:
First Name:AMINA
Middle Name:
Last Name:BALOCH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1S376 SUMMIT AVE
Mailing Address - Street 2:COURT C UNIT 4B
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3985
Mailing Address - Country:US
Mailing Address - Phone:708-945-4426
Mailing Address - Fax:
Practice Address - Street 1:1S376 SUMMIT AVE
Practice Address - Street 2:COURT C UNIT 4B
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-3985
Practice Address - Country:US
Practice Address - Phone:708-945-4426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014888363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology