Individual
NICOLE BALLACHINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5855 BREMO RD, RICHMOND, VA 23226-1930
(860) 301-5654
Mailing address
1113 E BROOKLAND PARK BLVD, RICHMOND, VA 23222-3110
(860) 301-5654
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0024179884
VA
363L00000X
Nurse Practitioner
Primary
0024179884
VA
Other
Enumeration date
11/07/2020
Last updated
05/18/2022
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