Provider Demographics
NPI:1497802672
Name:BALL, LISA SHERRY DEBBY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:SHERRY DEBBY
Last Name:BALL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:146 SAGEWOOD TER
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4718
Mailing Address - Country:US
Mailing Address - Phone:716-982-4165
Mailing Address - Fax:
Practice Address - Street 1:1140 YOUNGS RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8054
Practice Address - Country:US
Practice Address - Phone:716-688-0020
Practice Address - Fax:716-688-0020
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY520995163W00000X
NYF334452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1497802672Medicare PIN