Provider Demographics
NPI:1396135794
Name:NINFA E.BALANGUE
Entity type:Organization
Organization Name:NINFA E.BALANGUE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE/NURSE DELAGATOR
Authorized Official - Prefix:
Authorized Official - First Name:NINFA
Authorized Official - Middle Name:EVALOBO
Authorized Official - Last Name:BALANGUE
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:360-915-6549
Mailing Address - Street 1:9341 HART RD SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-9705
Mailing Address - Country:US
Mailing Address - Phone:360-915-6549
Mailing Address - Fax:360-915-6549
Practice Address - Street 1:9341 HART RD SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-9705
Practice Address - Country:US
Practice Address - Phone:360-915-6549
Practice Address - Fax:360-915-6549
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADSA NURSE DELEGATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00102147163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA11001485Medicaid