Individual
SHANA BALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
204 VALE ST, PALMER LAKE, CO 80133-9400
(719) 418-5097
Mailing address
204 VALE ST, PALMER LAKE, CO 80133-9400
(719) 418-5097
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
00700659
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2019477265
ASSISTED LIVING RESIDENCE
CO
Enumeration date
05/28/2020
Last updated
05/28/2020
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