Provider Demographics
NPI:1295342913
Name:BALL, EMILY COREEN (FNP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:COREEN
Last Name:BALL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9460 SCULLY RD
Mailing Address - Street 2:
Mailing Address - City:WHITMORE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48189-9690
Mailing Address - Country:US
Mailing Address - Phone:970-379-8773
Mailing Address - Fax:
Practice Address - Street 1:1145 S MAIN ST UNIT A
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1408
Practice Address - Country:US
Practice Address - Phone:517-205-8667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-27
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10941553-4405164W00000X
MI4704378073363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164W00000XNursing Service ProvidersLicensed Practical Nurse