Healthcare Provider Details

I. General information

NPI: 1598233306
Provider Name (Legal Business Name): NINA MILLS BALLANTYNE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NINA BALLANTYNE TORRES

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 03/23/2024
Certification Date: 03/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 DAMASCUS CIR
COSTA MESA CA
92626-1608
US

IV. Provider business mailing address

1017 DAMASCUS CIR
COSTA MESA CA
92626-1608
US

V. Phone/Fax

Practice location:
  • Phone: 413-687-9263
  • Fax: 714-707-4119
Mailing address:
  • Phone: 413-687-9263
  • Fax: 714-707-4119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95010744
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number235994
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: