Healthcare Provider Details

I. General information

NPI: 1184603466
Provider Name (Legal Business Name): MARY CATHERINE BALL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CARPENTER RD ANDREW RADER USA HEALTH CLINIC
FORT MYER VA
22211-1009
US

IV. Provider business mailing address

5900 RESERVOIR HEIGHTS AVE
ALEXANDRIA VA
22311-1010
US

V. Phone/Fax

Practice location:
  • Phone: 703-696-0078
  • Fax:
Mailing address:
  • Phone: 703-931-7699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number1054443
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: