Provider Demographics
NPI:1437802584
Name:BELANCE, MARIE YVES (FNP)
Entity Type:Individual
Prefix:
First Name:MARIE YVES
Middle Name:
Last Name:BELANCE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARIE YVES
Other - Middle Name:
Other - Last Name:BALTHAZAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BALTHAZAR
Mailing Address - Street 1:5 LESTER PL APT 1
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-1971
Mailing Address - Country:US
Mailing Address - Phone:914-494-9444
Mailing Address - Fax:
Practice Address - Street 1:111 E 210TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:718-920-9536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-29
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY633910163W00000X
NYF348540-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse