Provider Demographics
NPI:1063787133
Name:BALLENGER, VICKI LEE (RN)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:LEE
Last Name:BALLENGER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 COUNTY ROAD 24
Mailing Address - Street 2:
Mailing Address - City:ASHLEY
Mailing Address - State:OH
Mailing Address - Zip Code:43003-9668
Mailing Address - Country:US
Mailing Address - Phone:614-402-5728
Mailing Address - Fax:
Practice Address - Street 1:202 COUNTY ROAD 24
Practice Address - Street 2:
Practice Address - City:ASHLEY
Practice Address - State:OH
Practice Address - Zip Code:43003-9668
Practice Address - Country:US
Practice Address - Phone:614-402-5728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN407510163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management