Individual
CADESHA COREEN BALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1745 N 4TH ST, PHILADELPHIA, PA 19122-3008
(215) 236-0100
Mailing address
1745 N 4TH ST, PHILADELPHIA, PA 19122-3008
(215) 236-0100
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN28451
PA
Other
Enumeration date
04/17/2023
Last updated
04/17/2023
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