Provider Demographics
NPI:1396619755
Name:BALLER, PAYTON
Entity type:Individual
Prefix:
First Name:PAYTON
Middle Name:
Last Name:BALLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 DORCAS ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68108-1160
Mailing Address - Country:US
Mailing Address - Phone:402-926-4444
Mailing Address - Fax:402-393-8230
Practice Address - Street 1:825 DORCAS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68108-1160
Practice Address - Country:US
Practice Address - Phone:402-926-4444
Practice Address - Fax:402-393-8230
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker