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General NPI Number Information
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NPI Number | 1013075316
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Entity Type | Individual
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Provider Name | PEGGY BALLARD PLACE F.N.P.
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Gender | Female
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10052 ALTA SIERRA DR
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City | GRASS VALLEY
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State | CA
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Zip | 95949-6886
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Country | US
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Telephone | 530-477-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 16131 BROOKS RD
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City | GRASS VALLEY
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State | CA
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Zip | 95945-4314
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Country | US
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Telephone | 530-273-1320
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 10309
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License Number State | CA
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