1356588685 NPI number — MRS. SHEILA ROCHELLE BALLARD NURSING ASSISTANT

Table of content: MRS. SHEILA ROCHELLE BALLARD NURSING ASSISTANT (NPI 1356588685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356588685 NPI number — MRS. SHEILA ROCHELLE BALLARD NURSING ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALLARD
Provider First Name:
SHEILA
Provider Middle Name:
ROCHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NURSING ASSISTANT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MIXON
Provider Other First Name:
SHEILA
Provider Other Middle Name:
ROCHELLE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
NURSING ASSISTANT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356588685
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3580 RUE FORET
Provider Second Line Business Mailing Address:
88
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48532-2842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-882-8232
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3580 RUE FORET
Provider Second Line Business Practice Location Address:
88
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48532-2842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-882-8232
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WH0200X , with the licence number:  CERTIFICATE , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163WH1000X , with the licence number: CERTIFICATE , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)