Provider Demographics
NPI:1407190796
Name:BALL, THERESE MARIE (ANP)
Entity Type:Individual
Prefix:MRS
First Name:THERESE
Middle Name:MARIE
Last Name:BALL
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4371 TONAWANDA CREEK RD
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1042
Mailing Address - Country:US
Mailing Address - Phone:716-688-6075
Mailing Address - Fax:
Practice Address - Street 1:4371 TONAWANDA CREEK RD
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1042
Practice Address - Country:US
Practice Address - Phone:716-688-6075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF306283-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health