Provider Demographics
NPI:1609159425
Name:BALTZELL, JAMEE S (APRN)
Entity Type:Individual
Prefix:
First Name:JAMEE
Middle Name:S
Last Name:BALTZELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 N EAST ST
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-2462
Mailing Address - Country:US
Mailing Address - Phone:618-429-9470
Mailing Address - Fax:833-944-2035
Practice Address - Street 1:1108 N EAST ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-2462
Practice Address - Country:US
Practice Address - Phone:618-429-9470
Practice Address - Fax:833-944-2035
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000482363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily