Provider Demographics
NPI:1780254037
Name:BALAICH, JORDANN MAKAIL (RN)
Entity type:Individual
Prefix:
First Name:JORDANN
Middle Name:MAKAIL
Last Name:BALAICH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3065 LADY NICOLE LN
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55803-5202
Mailing Address - Country:US
Mailing Address - Phone:218-428-4552
Mailing Address - Fax:
Practice Address - Street 1:3065 LADY NICOLE LN
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55803-5202
Practice Address - Country:US
Practice Address - Phone:218-428-4552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2458036163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health