Provider Demographics
NPI:1992469639
Name:BALKEN, MIRIAM (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:
Last Name:BALKEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 AVENUE J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3315
Mailing Address - Country:US
Mailing Address - Phone:347-524-8896
Mailing Address - Fax:
Practice Address - Street 1:2512 AVENUE R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2408
Practice Address - Country:US
Practice Address - Phone:347-524-8896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF348657-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily