Provider Demographics
NPI:1184868762
Name:BALISTRERI, RITA NICHOLE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:RITA
Middle Name:NICHOLE
Last Name:BALISTRERI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3076 E BRUTUS RD
Mailing Address - Street 2:
Mailing Address - City:ALANSON
Mailing Address - State:MI
Mailing Address - Zip Code:49706-9492
Mailing Address - Country:US
Mailing Address - Phone:231-622-9032
Mailing Address - Fax:
Practice Address - Street 1:416 CONNABLE AVE
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2212
Practice Address - Country:US
Practice Address - Phone:231-487-4990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704263692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily