Provider Demographics
NPI:1598467888
Name:BALSER, BREANNE CHRISTINE
Entity Type:Individual
Prefix:
First Name:BREANNE
Middle Name:CHRISTINE
Last Name:BALSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13705 BITNEY SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-9751
Mailing Address - Country:US
Mailing Address - Phone:530-913-3115
Mailing Address - Fax:
Practice Address - Street 1:13705 BITNEY SPRINGS RD
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-9751
Practice Address - Country:US
Practice Address - Phone:530-913-3115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist