Healthcare Provider Details

I. General information

NPI: 1366543381
Provider Name (Legal Business Name): NATALIE ANN BALLWEBER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 TUTT BLVD SUITE 210
COLORADO SPGS CO
80922-3568
US

IV. Provider business mailing address

6160 TUTT BLVD SUITE 210
COLORADO SPGS CO
80922-3568
US

V. Phone/Fax

Practice location:
  • Phone: 719-636-0080
  • Fax: 719-636-3030
Mailing address:
  • Phone: 719-636-0080
  • Fax: 719-636-3030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number856
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: