| Doctor Name: | DR. MONIQUE BALTHAZAR |
| NPI Number: | 1699115790 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DNP, PHD, FNP-BC |
| License Number: | 12257 |
| Business Practice Address: | 40520 County Highway 34 Ogema, MN - 565699612 |
| Business Phone Number: | 2189836365 |
| Business Fax Number: | |
| Mailing Address: | 40520 County Highway 34, OGEMA |
| State: | MN |
| Postal Code: | 565699612 |
| Phone Number: | 2189836365 |
| Fax Number: | |
| NPI Enumeration Date: | 07/03/2013 |
| NPI Last Update Date: | 02/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 12257 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |