Provider Demographics
NPI:1407474935
Name:BALANI, ROULA (APRN)
Entity Type:Individual
Prefix:
First Name:ROULA
Middle Name:
Last Name:BALANI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 BLUE AGAVE LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-2329
Mailing Address - Country:US
Mailing Address - Phone:512-586-1194
Mailing Address - Fax:
Practice Address - Street 1:600 ROUND ROCK WEST DR STE 20
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5007
Practice Address - Country:US
Practice Address - Phone:512-666-3574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX138008363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily