Individual
THEJASWI BALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
19 RICKARD CT, LAWRENCE TOWNSHIP, NJ 08648-2668
(978) 677-0636
Mailing address
19 RICKARD CT, LAWRENCE TOWNSHIP, NJ 08648-2668
(978) 677-0636
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
26NR22298100
NJ
Other
Enumeration date
04/16/2022
Last updated
04/16/2022
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