Provider Demographics
NPI:1083091763
Name:BALLERINI, LISA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:BALLERINI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 SOUTHSHORE DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-3558
Mailing Address - Country:US
Mailing Address - Phone:248-980-5266
Mailing Address - Fax:
Practice Address - Street 1:653 SOUTHSHORE DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-3558
Practice Address - Country:US
Practice Address - Phone:248-980-5266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704250603163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse