Provider Demographics
NPI:1093170185
Name:BALL, MYWANZA (LVN)
Entity Type:Individual
Prefix:
First Name:MYWANZA
Middle Name:
Last Name:BALL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42139 SUMMER LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-3795
Mailing Address - Country:US
Mailing Address - Phone:661-348-8813
Mailing Address - Fax:484-970-9083
Practice Address - Street 1:42139 SUMMER LN
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-3795
Practice Address - Country:US
Practice Address - Phone:661-348-8813
Practice Address - Fax:484-970-9083
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN276138164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse