Individual
DR. SUSAN WANDA BALKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
171 CHERRY ST, MARIANNA, AR 72360-1938
(870) 295-6205
Mailing address
171 CHERRY ST, MARIANNA, AR 72360-1938
(870) 295-6205
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
N6963
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111863003
—
AR
Enumeration date
09/18/2005
Last updated
09/07/2007
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