| NPI | 1720616477 | 
|---|---|
| Former Name | KATIE ELIZABETH BALSAMO | 
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704361496) | 
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR18109500) | 
| Enumeration Date | 2020-03-30 | 
| Last Update Date | 2025-02-25 |