Individual
WILLIE BENJAMIN BALLOU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
4041 S MCCLINTOCK DR, TEMPE, AZ 85282-5879
(520) 233-7111
Mailing address
4041 S MCCLINTOCK DR, STE 311, TEMPE, AZ 85282-5879
(520) 233-7111
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
229136
AZ
363LA2200X
Adult Health Nurse Practitioner
AP127755
TX
Other
Enumeration date
04/23/2015
Last updated
07/07/2021
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