Provider Demographics
NPI:1518659283
Name:BALL, BRENDA (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:BALL
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6580 SNOWY RANGE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-5189
Mailing Address - Country:US
Mailing Address - Phone:719-214-3808
Mailing Address - Fax:
Practice Address - Street 1:6580 SNOWY RANGE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-5189
Practice Address - Country:US
Practice Address - Phone:719-214-3808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0190742163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant