Individual
WINIFRED GRACE WATSON BALADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4000
(713) 792-6161
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
AP141104
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
402833401
—
TX
01
—
402833402
MEDICAID-CSHCN
TX
01
—
8LT878
BCBS
TX
01
—
Q00091565
RAILROAD MEDICARE
TX
Enumeration date
02/12/2015
Last updated
11/30/2021
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