Healthcare Provider Details

I. General information

NPI: 1396142261
Provider Name (Legal Business Name): HEATHER BALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6707 WHITESTONE RD STE 106
WOODLAWN MD
21207-4140
US

IV. Provider business mailing address

7718 BRIDLE PATH CIR
FREDERICK MD
21701-3371
US

V. Phone/Fax

Practice location:
  • Phone: 301-265-8737
  • Fax:
Mailing address:
  • Phone: 301-898-3108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR157601
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: