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
Primary
95038680
CA
Other
Enumeration date
10/23/2024
Last updated
03/26/2026
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