Provider Demographics
NPI:1578768610
Name:BALLENGER, DENISE LOUISE (RNFA)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:LOUISE
Last Name:BALLENGER
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 S. GARDEN WAY,
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-686-8700
Mailing Address - Fax:541-686-9004
Practice Address - Street 1:330 S. GARDEN WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-686-8700
Practice Address - Fax:541-686-9004
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR091003301RN163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR091003301RNOtherRNFA