Provider Demographics
NPI:1497373161
Name:BALLARA, IVETTE (RN)
Entity Type:Individual
Prefix:MS
First Name:IVETTE
Middle Name:
Last Name:BALLARA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 BEECHWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2309
Mailing Address - Country:US
Mailing Address - Phone:404-272-2224
Mailing Address - Fax:
Practice Address - Street 1:3400 OLD MILTON PKWY STE 330
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3707
Practice Address - Country:US
Practice Address - Phone:770-667-3090
Practice Address - Fax:678-867-0929
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN183718163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery