Provider Demographics
NPI:1134560758
Name:BALLUCH-DEAN, ANDREA ELAINE (CNP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:ELAINE
Last Name:BALLUCH-DEAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 BOARDMAN CANFIELD RD STE 324
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4804
Mailing Address - Country:US
Mailing Address - Phone:724-866-1750
Mailing Address - Fax:724-618-4128
Practice Address - Street 1:3610 MERCEDES PL
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-8139
Practice Address - Country:US
Practice Address - Phone:724-866-1750
Practice Address - Fax:724-618-4128
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH341812163W00000X
OH14803363LF0000X
OHAPRN.CNP.14803363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily