Provider Demographics
NPI:1114407616
Name:BALLAH, MAE (RN)
Entity Type:Individual
Prefix:
First Name:MAE
Middle Name:
Last Name:BALLAH
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 1:11950 FM 1960 RD W APT 922
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-3695
Mailing Address - Country:US
Mailing Address - Phone:832-756-3249
Mailing Address - Fax:
Practice Address - Street 1:11950 FM 1960 RD W APT 922
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3695
Practice Address - Country:US
Practice Address - Phone:832-756-3249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX949310163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse