Provider Demographics
NPI:1831442482
Name:BALLENSKY, ASHLEY L (RN)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:L
Last Name:BALLENSKY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:FORT HALL
Mailing Address - State:ID
Mailing Address - Zip Code:83203-0717
Mailing Address - Country:US
Mailing Address - Phone:208-238-5423
Mailing Address - Fax:208-238-5465
Practice Address - Street 1:717 MISSION ROAD
Practice Address - Street 2:
Practice Address - City:FORT HALL
Practice Address - State:ID
Practice Address - Zip Code:83203-0717
Practice Address - Country:US
Practice Address - Phone:208-238-5423
Practice Address - Fax:208-238-5465
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-39540163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care