Provider Demographics
NPI:1447379334
Name:BALAN, MAGDALENA (CNP)
Entity Type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:
Last Name:BALAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 OAKWOOD BLVD
Mailing Address - Street 2:P.O. BOX 2802
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2319
Mailing Address - Country:US
Mailing Address - Phone:313-359-7600
Mailing Address - Fax:313-359-7660
Practice Address - Street 1:840 OAKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2319
Practice Address - Country:US
Practice Address - Phone:313-359-7600
Practice Address - Fax:313-359-7660
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704214887363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner