Provider Demographics
NPI:1568770030
Name:BALLINGER, LORI LEA (CGC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LEA
Last Name:BALLINGER
Suffix:
Gender:F
Credentials:CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MSC 07 4025
Mailing Address - Street 2:UNM CANCER RESEARCH AND TREATMENT CENTER
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-925-0102
Mailing Address - Fax:505-925-0187
Practice Address - Street 1:MSC 07 4025
Practice Address - Street 2:UNM CANCER RESEARCH AND TREATMENT CENTER
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-925-0102
Practice Address - Fax:505-925-0187
Is Sole Proprietor?:No
Enumeration Date:2010-09-18
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMGC2009-009170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS