Provider Demographics
NPI:1578814125
Name:BALASHOVA, NATASHA (LPN, RN)
Entity Type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:
Last Name:BALASHOVA
Suffix:
Gender:F
Credentials:LPN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 N DORADO CIR APT 1A
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4610
Mailing Address - Country:US
Mailing Address - Phone:631-605-4745
Mailing Address - Fax:
Practice Address - Street 1:219 SPRINGMEADOW DR
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4124
Practice Address - Country:US
Practice Address - Phone:631-605-4304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-23
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311590164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse