Provider Demographics
NPI:1477597060
Name:BALKA, CATHERINE LOUISE (APRN)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:LOUISE
Last Name:BALKA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:CATHY
Other - Middle Name:SELACK
Other - Last Name:BALKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1543 WINWARD DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-7535
Mailing Address - Country:US
Mailing Address - Phone:801-582-1565
Mailing Address - Fax:801-584-2544
Practice Address - Street 1:1543 WINWARD DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-7535
Practice Address - Country:US
Practice Address - Phone:801-582-1565
Practice Address - Fax:801-584-2544
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT188294-4405363LP0808X
UT188294-8900363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT188294-4405OtherAPRN LICENSE
UT188294-8900OtherAPRN CONTROLLED SUBSTANCE