Individual
PHILLIP WILLIAM BALZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1200 E BROAD ST, RICHMOND, VA 23298-5058
(804) 828-9000
Mailing address
5205 TIMBERCREEK DR, NORTH CHESTERFIELD, VA 23237-3169
(864) 907-3265
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001250924
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
0024178743
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001250924
RN LICENCE
VA
01
—
0024178743
NURSE PRACTITIONER LICENSE
VA
Enumeration date
01/28/2020
Last updated
01/28/2020
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