Provider Demographics
NPI:1508362682
Name:BALCIUS-SULLIVAN, BARBARA JEAN (CLPN)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:JEAN
Last Name:BALCIUS-SULLIVAN
Suffix:
Gender:F
Credentials:CLPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-1106
Mailing Address - Country:US
Mailing Address - Phone:508-510-5133
Mailing Address - Fax:580-583-9800
Practice Address - Street 1:177 CARROLL AVE
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-6315
Practice Address - Country:US
Practice Address - Phone:508-510-5133
Practice Address - Fax:508-583-9800
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN56419164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse