Healthcare Provider Details

I. General information

NPI: 1720194541
Provider Name (Legal Business Name): CYNTHIA JANE BALL R.D., C.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CYNTHIA JANE NANNIE R.D., C.D.

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E 38TH ST
MARION IN
46953-4568
US

IV. Provider business mailing address

411 N BITTERSWEET LN
MUNCIE IN
47304-3734
US

V. Phone/Fax

Practice location:
  • Phone: 765-674-3321
  • Fax:
Mailing address:
  • Phone: 765-284-6513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37000546A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: