Provider Demographics
NPI:1982773859
Name:BALCH, MARILYN R (APN)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:R
Last Name:BALCH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:MARLYN
Other - Middle Name:R
Other - Last Name:DROEGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 N 2ND ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068-1717
Mailing Address - Country:US
Mailing Address - Phone:815-562-3784
Mailing Address - Fax:815-561-8286
Practice Address - Street 1:900 N 2ND ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHELLE
Practice Address - State:IL
Practice Address - Zip Code:61068-1717
Practice Address - Country:US
Practice Address - Phone:815-562-3784
Practice Address - Fax:815-561-8286
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209002897363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL705380Medicare PIN
ILP32136Medicare UPIN