MEDICARE: SHEILA BALLINGER LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	077643	OH

General Provider Information

NPI Number	:	1093144388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEILA BALLINGER LPN

Provider Business Mailing Address
First Line	:	319 W CENTER
Second Line	:
City	:	WEST MANSFIELD
State	:	OH
Zip	:	43358
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	319 W CENTER STREET
Second Line	:
City	:	WEST MANSFIELD
State	:	OH
Zip	:	43358
Country	:	US
Telephone Number	:	937-355-3054
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2013
Last Update Date	:	11/06/2013

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