Provider Demographics
NPI:1518262997
Name:BALLINGER, AMBER LEE (LPN)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LEE
Last Name:BALLINGER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 BROOK RUN CT
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3608
Mailing Address - Country:US
Mailing Address - Phone:614-787-2739
Mailing Address - Fax:
Practice Address - Street 1:687 BROOK RUN CT
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-3608
Practice Address - Country:US
Practice Address - Phone:614-787-2739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.103184 MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse