Basic Information
| Provider Information | |||||||||
| NPI: | 1487744124 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALESTRI | ||||||||
| FirstName: | CAMILLE | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 76 CARLON DR # B | ||||||||
| Address2: | |||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010602373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135842178 | ||||||||
| FaxNumber: | 4135864233 | ||||||||
| Practice Location | |||||||||
| Address1: | 76 CARLON DR # B | ||||||||
| Address2: | |||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010602373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135842178 | ||||||||
| FaxNumber: | 4135864233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 363L00000X | 162545 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.