Provider Demographics
NPI:1194153494
Name:BALCOM, JULIA ESTHER (MN,BSN)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ESTHER
Last Name:BALCOM
Suffix:
Gender:F
Credentials:MN,BSN
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:ESTHER
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1517
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0410
Mailing Address - Country:US
Mailing Address - Phone:877-708-1119
Mailing Address - Fax:541-278-8349
Practice Address - Street 1:531 SE CLAY ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-2865
Practice Address - Country:US
Practice Address - Phone:971-612-6100
Practice Address - Fax:971-612-6101
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201391421NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily