Provider Demographics
NPI:1649361585
Name:BALKAM, JANE JOHNSTON (PHD, APRN, CPNP,IBCL)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:JOHNSTON
Last Name:BALKAM
Suffix:
Gender:F
Credentials:PHD, APRN, CPNP,IBCL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10117 PARKWOOD TER
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4035
Mailing Address - Country:US
Mailing Address - Phone:301-656-2526
Mailing Address - Fax:301-897-8181
Practice Address - Street 1:10117 PARKWOOD TER
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4035
Practice Address - Country:US
Practice Address - Phone:301-656-2526
Practice Address - Fax:301-897-8181
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2016-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR062391363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD163WL0100XOtherRN LACTATION CONSULTANT