Individual
ANGELA BALCOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
310 BROADWAY, REVERE, MA 02151-5035
(781) 289-2266
Mailing address
710 QUINNIPIAC AVE, NEW HAVEN, CT 06513-4007
Taxonomy
Speciality
Code
Description
License number
State
163WW0101X
Ambulatory Women's Health Care Registered Nurse
RN10013081
MA
363LW0102X
Women's Health Nurse Practitioner
Primary
RN10013081
MA
Other
Enumeration date
07/24/2024
Last updated
12/20/2024
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