Basic Information
| Provider Information | |||||||||
| NPI: | 1265912323 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALEK | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | JESSICA LEE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21529 SHOREVISTA LN | ||||||||
| Address2: | |||||||||
| City: | NOBLESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460626793 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178284788 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8060 KNUE RD | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462501976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178138900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2018 | ||||||||
| LastUpdateDate: | 08/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 10002535A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.