Provider Demographics
NPI:1316458359
Name:BALFANZ, REBECCA E (MSN, RN, CPNP-PC)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:E
Last Name:BALFANZ
Suffix:
Gender:F
Credentials:MSN, RN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 LARKSPUR LN
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-4446
Mailing Address - Country:US
Mailing Address - Phone:409-679-9125
Mailing Address - Fax:
Practice Address - Street 1:3220 CENTRAL MALL DR
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8037
Practice Address - Country:US
Practice Address - Phone:409-729-7900
Practice Address - Fax:409-729-7900
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX831310363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics