Provider Demographics
NPI:1457653511
Name:BALBICK, JANE R (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:R
Last Name:BALBICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-3805
Mailing Address - Country:US
Mailing Address - Phone:585-343-2480
Mailing Address - Fax:585-815-0512
Practice Address - Street 1:411 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-3805
Practice Address - Country:US
Practice Address - Phone:585-343-2480
Practice Address - Fax:585-815-0512
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330171-1363L00000X, 364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner