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General NPI Number Information
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NPI Number | 1104588896
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Entity Type | Individual
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Provider Name | NIKI R BALL NP
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Gender | Female
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Dates
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Enumeration Date | 10/10/2021
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Last Update Date | 08/10/2022
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Provider Practice Location Address
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Address Line | 2117 SPRINGWELLS ST
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City | DETROIT
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State | MI
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Zip | 48209-1507
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Country | US
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Telephone | 313-908-2927
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Fax |
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Provider Business Mailing Address
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Address Line | 159 N GENESEE AVE
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City | PONTIAC
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State | MI
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Zip | 48341-1108
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Country | US
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Telephone |
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 4704285484
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License Number State | MI
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