Provider Demographics
NPI:1124554019
Name:BALLING, CHRISTINA ANGELIC
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:ANGELIC
Last Name:BALLING
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 1:611 JEFFERSON DAVIS HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-8402
Mailing Address - Country:US
Mailing Address - Phone:540-371-4141
Mailing Address - Fax:
Practice Address - Street 1:611 JEFFERSON DAVIS HWY STE 201
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8402
Practice Address - Country:US
Practice Address - Phone:540-371-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174778363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care