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Individual

ALICIA RENEE BALOK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN, IBCLC

Contact information

Practice address
1016 E ROOSEVELT AVE, GRANTS, NM 87020-2118
(505) 287-4446
Mailing address
503 S GRANDVIEW DR, GALLUP, NM 87301-6019
(505) 879-0212

Taxonomy

Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
RN-74890
NM

Other

Enumeration date
12/08/2020
Last updated
12/08/2020
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