Provider Demographics
NPI:1730895301
Name:BALCERZAK, BREANNA LYNN (BSN-RN)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:LYNN
Last Name:BALCERZAK
Suffix:
Gender:F
Credentials:BSN-RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:NY
Mailing Address - Zip Code:14006-9770
Mailing Address - Country:US
Mailing Address - Phone:716-480-5859
Mailing Address - Fax:
Practice Address - Street 1:8220 HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:NY
Practice Address - Zip Code:14006-9770
Practice Address - Country:US
Practice Address - Phone:716-480-5859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY789346-01163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics