Provider Demographics
NPI:1891560785
Name:BALTZOR, MICHELLE LANE ROCA (NBC-HWC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LANE ROCA
Last Name:BALTZOR
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41118 TAYLOR LN
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-9825
Mailing Address - Country:US
Mailing Address - Phone:541-561-4163
Mailing Address - Fax:
Practice Address - Street 1:41118 TAYLOR LN
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-9825
Practice Address - Country:US
Practice Address - Phone:541-561-4163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA-3668707171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach