Provider Demographics
NPI:1932239720
Name:BALK, JULIE P (NP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:P
Last Name:BALK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:PANNIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6611 BENECIA DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3487
Mailing Address - Country:US
Mailing Address - Phone:801-942-0878
Mailing Address - Fax:801-572-1097
Practice Address - Street 1:12176 S 1000 E
Practice Address - Street 2:STE. D
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9716
Practice Address - Country:US
Practice Address - Phone:801-572-3750
Practice Address - Fax:801-572-1097
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT212013-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
R82473Medicare UPIN