Provider Demographics
NPI:1639567233
Name:JOANNA BALLARD HOME MIDWIFERY CARE
Entity Type:Organization
Organization Name:JOANNA BALLARD HOME MIDWIFERY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LM
Authorized Official - Phone:307-256-6633
Mailing Address - Street 1:421 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-4307
Mailing Address - Country:US
Mailing Address - Phone:307-256-6633
Mailing Address - Fax:303-997-1818
Practice Address - Street 1:421 S 19TH ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-4307
Practice Address - Country:US
Practice Address - Phone:307-256-6633
Practice Address - Fax:303-997-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY008176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty