Provider Demographics
NPI:1619241700
Name:BALSICK, MARYNEL A (RN)
Entity Type:Individual
Prefix:
First Name:MARYNEL
Middle Name:A
Last Name:BALSICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30800 TELEGRAPH RD STE 2800
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5704
Mailing Address - Country:US
Mailing Address - Phone:248-593-0100
Mailing Address - Fax:248-593-0117
Practice Address - Street 1:30800 TELEGRAPH RD STE 2800
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-5704
Practice Address - Country:US
Practice Address - Phone:248-593-0100
Practice Address - Fax:248-593-0117
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704194632163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management