Provider Demographics
NPI:1144791229
Name:BALLETTO, ASHLEY ROCHELLE (RN)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ROCHELLE
Last Name:BALLETTO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:ROCHELLE
Other - Last Name:WELKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 895
Mailing Address - Street 2:
Mailing Address - City:PABLO
Mailing Address - State:MT
Mailing Address - Zip Code:59855-0895
Mailing Address - Country:US
Mailing Address - Phone:707-294-5589
Mailing Address - Fax:
Practice Address - Street 1:35401 MISSION DR
Practice Address - Street 2:
Practice Address - City:ST. IGNATIUS
Practice Address - State:MT
Practice Address - Zip Code:59865
Practice Address - Country:US
Practice Address - Phone:406-849-5798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-RN-LIC-126737163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management