Provider Demographics
NPI:1811981673
Name:BALL, SANDRA LYNN (PA)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:BALL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:SANDY
Other - Middle Name:LYNN
Other - Last Name:BORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:1518 MULBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-3433
Mailing Address - Country:US
Mailing Address - Phone:563-262-4113
Mailing Address - Fax:563-264-9167
Practice Address - Street 1:1518 MULBERRY AVE
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-3433
Practice Address - Country:US
Practice Address - Phone:563-262-4113
Practice Address - Fax:563-264-9167
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000765363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA72797OtherWELLMARK BCBS
S98152Medicare UPIN
IA72797OtherWELLMARK BCBS