Provider Demographics
NPI:1760760540
Name:BALZARANO, VICTORIA LYNN (RN)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:LYNN
Last Name:BALZARANO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:VICTORIA
Other - Middle Name:LYNN
Other - Last Name:SHEEHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:417 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-1808
Mailing Address - Country:US
Mailing Address - Phone:814-254-4502
Mailing Address - Fax:
Practice Address - Street 1:417 MAIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1808
Practice Address - Country:US
Practice Address - Phone:814-254-4502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN510974L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN510974LOtherREGISTERED NURSE STATE LICENSE