Provider Demographics
NPI:1609430214
Name:BALL, RENEA LYNNE
Entity Type:Individual
Prefix:
First Name:RENEA
Middle Name:LYNNE
Last Name:BALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 CAJON ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5980
Mailing Address - Country:US
Mailing Address - Phone:469-217-4118
Mailing Address - Fax:
Practice Address - Street 1:416 FRONT ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2124
Practice Address - Country:US
Practice Address - Phone:740-516-6062
Practice Address - Fax:740-371-7778
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLE-00028116363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner