Provider Demographics
NPI:1922153147
Name:BALSAMO, WILLETTE CANNON (RN)
Entity Type:Individual
Prefix:MS
First Name:WILLETTE
Middle Name:CANNON
Last Name:BALSAMO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SOUTH LEXINGTON 4402, 6A
Mailing Address - Street 2:
Mailing Address - City:HEIDELBERG
Mailing Address - State:GERMANY
Mailing Address - Zip Code:69124
Mailing Address - Country:DE
Mailing Address - Phone:049622-117-3399
Mailing Address - Fax:
Practice Address - Street 1:U.S. MILITARY HOSPITAL, NACHRICHTEN KASERNE
Practice Address - Street 2:KARLSRUHER STR 144
Practice Address - City:HEIDELBERG
Practice Address - State:GERMANY
Practice Address - Zip Code:69126
Practice Address - Country:DE
Practice Address - Phone:049622-117-3399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN38547163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine