Provider Demographics
NPI:1013426352
Name:BALZARETTI, CARLEE Y (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CARLEE
Middle Name:Y
Last Name:BALZARETTI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:CARLEE
Other - Middle Name:Y
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:744 OAK ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-2544
Mailing Address - Country:US
Mailing Address - Phone:1510-409-1913
Mailing Address - Fax:
Practice Address - Street 1:750 REDWOOD HWY FRONTAGE RD STE 1204
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2483
Practice Address - Country:US
Practice Address - Phone:415-384-4778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006713363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily