Organization
JAN NELSON NP-C, DBA, BALANCED WELLNESS MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANICE NELSON (OWNER)
(208) 651-3322
Entity
Organization
Contact information
Practice address
1328 N STANFORD LN, 101, LIBERTY LAKE, WA 99019-5034
(509) 891-7119
Mailing address
PO BOX 2808, HAYDEN, ID 83835-2808
(208) 651-3322
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
AP60478189
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1538314257
NPI
—
Enumeration date
09/19/2014
Last updated
09/19/2014
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