Provider Demographics
NPI:1023826021
Name:BALDERAS, CARMELITA
Entity type:Individual
Prefix:MRS
First Name:CARMELITA
Middle Name:
Last Name:BALDERAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 PARK ST
Mailing Address - Street 2:
Mailing Address - City:JEWELL
Mailing Address - State:IA
Mailing Address - Zip Code:50130-2021
Mailing Address - Country:US
Mailing Address - Phone:515-290-3229
Mailing Address - Fax:
Practice Address - Street 1:511 PARK ST
Practice Address - Street 2:
Practice Address - City:JEWELL
Practice Address - State:IA
Practice Address - Zip Code:50130-2021
Practice Address - Country:US
Practice Address - Phone:515-290-3229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-21
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula