Provider Demographics
NPI:1124418470
Name:BALLINGER, ROSETTA
Entity Type:Individual
Prefix:
First Name:ROSETTA
Middle Name:
Last Name:BALLINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 FORBUS ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45214-1340
Mailing Address - Country:US
Mailing Address - Phone:513-418-3726
Mailing Address - Fax:
Practice Address - Street 1:1811 FORBUS ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45214-1340
Practice Address - Country:US
Practice Address - Phone:513-418-3726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide