Individual
TIFFANY BALLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1111 E END BLVD, WILKES BARRE, PA 18711-0030
(570) 824-3521
Mailing address
131 CENTER AVE APT 1, PLYMOUTH, PA 18651-2234
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN298596
PA
Other
Enumeration date
04/24/2018
Last updated
04/24/2018
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