Healthcare Provider Details

I. General information

NPI: 1295274561
Provider Name (Legal Business Name): NEVIN BALLIET
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2017
Last Update Date: 02/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 N WALNUT ST
MOUNT CARMEL PA
17851-1629
US

IV. Provider business mailing address

9 N WALNUT ST
MOUNT CARMEL PA
17851-1629
US

V. Phone/Fax

Practice location:
  • Phone: 570-459-1400
  • Fax: 570-459-1400
Mailing address:
  • Phone: 570-459-1400
  • Fax: 570-459-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberF30648
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: