Provider Demographics
NPI:1669789673
Name:BALZER, MISTI DIANEE (CPM)
Entity type:Individual
Prefix:
First Name:MISTI
Middle Name:DIANEE
Last Name:BALZER
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 N WHITNEY ST
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-0441
Mailing Address - Country:US
Mailing Address - Phone:904-806-6240
Mailing Address - Fax:
Practice Address - Street 1:218 N WHITNEY ST
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-0441
Practice Address - Country:US
Practice Address - Phone:904-806-6240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife