Provider Demographics
NPI:1528207297
Name:BALLA, ELIZABETH ROSCHER (RN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ROSCHER
Last Name:BALLA
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 1:3000 JOHNSON RD SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-5847
Mailing Address - Country:US
Mailing Address - Phone:256-650-1701
Mailing Address - Fax:256-650-1780
Practice Address - Street 1:3000 JOHNSON RD SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-5847
Practice Address - Country:US
Practice Address - Phone:256-650-1701
Practice Address - Fax:256-650-1780
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-040514163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse