Provider Demographics
NPI:1356588685
Name:BALLARD, SHEILA ROCHELLE (NURSING ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:ROCHELLE
Last Name:BALLARD
Suffix:
Gender:F
Credentials:NURSING ASSISTANT
Other - Prefix:MS
Other - First Name:SHEILA
Other - Middle Name:ROCHELLE
Other - Last Name:MIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSING ASSISTANT
Mailing Address - Street 1:3580 RUE FORET
Mailing Address - Street 2:88
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-2842
Mailing Address - Country:US
Mailing Address - Phone:810-882-8232
Mailing Address - Fax:
Practice Address - Street 1:3580 RUE FORET
Practice Address - Street 2:88
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-2842
Practice Address - Country:US
Practice Address - Phone:810-882-8232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICERTIFICATE163WH0200X, 163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice