Provider Demographics
NPI:1730108119
Name:BALACKI, MARGARET F (MSN-CRNP/PMH)
Entity Type:Individual
Prefix:PROF
First Name:MARGARET
Middle Name:F
Last Name:BALACKI
Suffix:
Gender:F
Credentials:MSN-CRNP/PMH
Other - Prefix:MRS
Other - First Name:MARGARET
Other - Middle Name:RUTH
Other - Last Name:FOOTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:803 LATCHMERE CT
Mailing Address - Street 2:UNIT 103
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-8268
Mailing Address - Country:US
Mailing Address - Phone:410-825-2281
Mailing Address - Fax:410-825-0757
Practice Address - Street 1:1407 YORK RD
Practice Address - Street 2:SUITE 309
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6097
Practice Address - Country:US
Practice Address - Phone:410-825-2281
Practice Address - Fax:410-825-0757
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR061828363LP0808X, 364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR061828OtherLICENSE
MDN51941OtherCDS
MDN51941OtherCDS
MDC742Medicare ID - Type Unspecified
NY281691Medicare ID - Type Unspecified
MDR061828OtherLICENSE