Individual
DESTINY SHANTEE BALLANCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN, APRN, FNP-BC
Contact information
Practice address
11175 AZUSA CT STE 110, RANCHO CUCAMONGA, CA 91730-4933
(909) 715-9611
Mailing address
11175 AZUSA CT STE 110, RANCHO CUCAMONGA, CA 91730-4933
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
95042920
CA
163WG0000X
General Practice Registered Nurse
95042920
CA
363L00000X
Nurse Practitioner
359569
NY
363L00000X
Nurse Practitioner
Primary
95038680
CA
363L00000X
Nurse Practitioner
AP70114616
WA
Other
Enumeration date
10/23/2024
Last updated
08/04/2026
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