Provider Demographics
NPI:1962905612
Name:BALZANO, CATHY (FNP)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:BALZANO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 E BELL RD STE 4500
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2171
Mailing Address - Country:US
Mailing Address - Phone:602-633-3838
Mailing Address - Fax:602-633-3845
Practice Address - Street 1:13555 W MCDOWELL RD STE 103
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2625
Practice Address - Country:US
Practice Address - Phone:623-932-1157
Practice Address - Fax:623-932-1045
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ086499163W00000X
AZ223221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ521142Medicaid
AZZ227298OtherMEDICARE