Provider Demographics
NPI:1952510331
Name:BALL, LORETTA ANN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:ANN
Last Name:BALL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:SANTA CLAUS
Mailing Address - State:IN
Mailing Address - Zip Code:47579-0719
Mailing Address - Country:US
Mailing Address - Phone:310-951-5115
Mailing Address - Fax:
Practice Address - Street 1:819 WERNSING RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-8141
Practice Address - Country:US
Practice Address - Phone:877-291-6488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9684363LF0000X
IN71008841A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily