Provider Demographics
NPI:1275635419
Name:BALL, LAUREEN K (CFNP)
Entity Type:Individual
Prefix:MS
First Name:LAUREEN
Middle Name:K
Last Name:BALL
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4333 W ST JOE HWY
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-4100
Mailing Address - Country:US
Mailing Address - Phone:517-321-1525
Mailing Address - Fax:517-321-7059
Practice Address - Street 1:4333 W ST JOE HWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4100
Practice Address - Country:US
Practice Address - Phone:517-321-1525
Practice Address - Fax:517-321-7059
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704174812363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
0875215OtherBCBS
MI1275635419Medicaid
Q44360Medicare UPIN
0P20130001Medicare PIN