Individual
WILMA DIANE BALIEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
1660 SPRINGHILL AVENUE, MOBILE, AL 36640-0430
(251) 665-8000
(251) 665-8010
Mailing address
PO BOX 40430, MOBILE, AL 36640-0430
(251) 665-8000
(251) 665-8010
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1-046774
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00985524
—
MS
01
—
051544202
BCBS - 1660 SPRINGHILL AVE
AL
05
—
308566000
—
FL
01
—
51542600
BCBS - HSF
AL
05
—
891017418
—
AL
Enumeration date
05/07/2007
Last updated
06/03/2015
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