Provider Demographics
NPI:1013634716
Name:BALL, STEPHANIE ANNE (BSN-RN, WCC, OMS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANNE
Last Name:BALL
Suffix:
Gender:F
Credentials:BSN-RN, WCC, OMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BRADLEY RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04461-3619
Mailing Address - Country:US
Mailing Address - Phone:207-551-6553
Mailing Address - Fax:
Practice Address - Street 1:120 BRADLEY RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:ME
Practice Address - Zip Code:04461-3619
Practice Address - Country:US
Practice Address - Phone:207-551-6553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN66715163WW0000X, 163W00000X, 163WG0600X, 163WX1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163W00000XNursing Service ProvidersRegistered Nurse
No163WG0600XNursing Service ProvidersRegistered NurseGerontologyGroup - Single Specialty
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care