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NPI Code Detail

MEDICARE: ANGELA FARAH BALLAS APRN

MEDICARE: ANGELA FARAH BALLAS APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner005514CT
2363L00000XNurse Practitioner5514CT

General Provider Information

NPI Number : 1891122362
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA FARAH BALLAS APRN
Provider Business Mailing Address
First Line : 55 HATCHETTS HILL RD
Second Line :
City : OLD LYME
State : CT
Zip : 06371-1534
Country : US
Telephone Number : 800-370-3651
Fax Number :
Provider Business Practice Location Address
First Line : 55 HATCHETTS HILL RD
Second Line :
City : OLD LYME
State : CT
Zip : 06371-1534
Country : US
Telephone Number : 800-370-3651
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2013
Last Update Date : 10/12/2017

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