Provider Demographics
NPI:1497818413
Name:BALL, JOAN E (RN, CNM)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:E
Last Name:BALL
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:E
Other - Last Name:BLICKENSTAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CNM
Mailing Address - Street 1:2965 E TARPON DR
Mailing Address - Street 2:STE 150
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9007
Mailing Address - Country:US
Mailing Address - Phone:208-376-2522
Mailing Address - Fax:208-375-5860
Practice Address - Street 1:4700 N CLOVERDALE RD
Practice Address - Street 2:STE 103
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-1067
Practice Address - Country:US
Practice Address - Phone:208-376-2522
Practice Address - Fax:208-375-5860
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCNM-12A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife