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Individual

JACQUELINE BALON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
30055 NORTHWESTERN HWY, STE L50, FARMINGTON HILLS, MI 48334-3230
(248) 626-8200
(248) 737-9287
Mailing address
PO BOX 120070, GRAND RAPIDS, MI 49528-0102
(616) 940-0660
(616) 940-1965

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704100757
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0866685
BCBSM
01
13834
MCARE
MI
05
4362714
MI
05
4790050
MI
01
P30273
HEALTH ALLIANCE PLAN
Enumeration date
04/12/2006
Last updated
09/12/2007
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