Individual
MICHELLE DICHOSO BALLESTEROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FOSTER CARE PROVIDER
Contact information
Practice address
631 SW TAFT ST, MCMINNVILLE, OR 97128-6627
(971) 330-5503
Mailing address
631 SW TAFT ST, MCMINNVILLE, OR 97128-6627
(971) 330-5503
Taxonomy
Speciality
Code
Description
License number
State
376G00000X
Nursing Home Administrator
Primary
623110
OR
Other
Enumeration date
07/18/2024
Last updated
11/15/2024
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