Provider Demographics
NPI:1154707966
Name:BALIS, JESSE ELIZABETH
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:ELIZABETH
Last Name:BALIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 HOLLY CT
Mailing Address - Street 2:
Mailing Address - City:BETHANY BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19930-9638
Mailing Address - Country:US
Mailing Address - Phone:980-422-3772
Mailing Address - Fax:
Practice Address - Street 1:612 HOLLY CT
Practice Address - Street 2:
Practice Address - City:BETHANY BEACH
Practice Address - State:DE
Practice Address - Zip Code:19930-9638
Practice Address - Country:US
Practice Address - Phone:980-422-3772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0047085163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse