Provider Demographics
NPI:1861002651
Name:BALLABEN, ELISABETTA TERESA (RD)
Entity Type:Individual
Prefix:
First Name:ELISABETTA
Middle Name:TERESA
Last Name:BALLABEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 AVENTINE DR APT 426
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-0288
Mailing Address - Country:US
Mailing Address - Phone:336-437-5467
Mailing Address - Fax:
Practice Address - Street 1:1000 AVENTINE DR APT 426
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-0288
Practice Address - Country:US
Practice Address - Phone:336-437-5467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered