Provider Demographics
NPI:1184868762
Name:BALISTRERI, RITA NICHOLE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:RITA
Middle Name:NICHOLE
Last Name:BALISTRERI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8881 M 119
Mailing Address - Street 2:
Mailing Address - City:HARBOR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49740-9479
Mailing Address - Country:US
Mailing Address - Phone:231-347-5400
Mailing Address - Fax:231-348-2515
Practice Address - Street 1:8881 M 119
Practice Address - Street 2:
Practice Address - City:HARBOR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49740-9586
Practice Address - Country:US
Practice Address - Phone:231-347-5400
Practice Address - Fax:231-348-2515
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704263692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily