Individual
KATHLEEN M BALANTIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
75 EASTERN POINT RD, GROTON, CT 06340-4905
(860) 833-9390
Mailing address
75 EASTERN POINT RD, GROTON, CT 06340-4905
(860) 833-9390
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
6429
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004190302
—
CT
01
—
050001247CT01
ANTHEM BLUE CROSS
CT
Enumeration date
12/18/2006
Last updated
05/26/2016
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