Individual
JACQUELYN BALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3718 MARTINDALE RD NE, APT L, CANTON, OH 44714-1355
(330) 224-7159
Mailing address
3718 MARTINDALE RD NE, APT L, CANTON, OH 44714-1355
(330) 224-7159
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
401595651213
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0151610
—
OH
Enumeration date
03/22/2016
Last updated
03/22/2016
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