Provider Demographics
NPI:1164468476
Name:BALL, LEONORA M (APN-C)
Entity Type:Individual
Prefix:
First Name:LEONORA
Middle Name:M
Last Name:BALL
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:LEONORA
Other - Middle Name:M
Other - Last Name:NIEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:3 COOPER PLZ
Practice Address - Street 2:SUITE 411
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-342-2270
Practice Address - Fax:856-365-1180
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP005760C363LA2200X
NJNJ00122700363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJNO10080700OtherSTATE LICENSE
NJ0136875Medicaid
NJ0136875Medicaid
106345AFEMedicare PIN