Healthcare Provider Details

I. General information

NPI: 1013634716
Provider Name (Legal Business Name): STEPHANIE ANNE BALL BSN-RN, WCC, OMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BRADLEY RD
MILFORD ME
04461-3619
US

IV. Provider business mailing address

120 BRADLEY RD
MILFORD ME
04461-3619
US

V. Phone/Fax

Practice location:
  • Phone: 207-551-6553
  • Fax:
Mailing address:
  • Phone: 207-551-6553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberRN66715
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN66715
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN66715
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License NumberRN66715
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: