Provider Demographics
NPI:1093018988
Name:BALLINGER, KELLY ELIZABETH (RN)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ELIZABETH
Last Name:BALLINGER
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 1:635 N ERIE ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-5317
Mailing Address - Country:US
Mailing Address - Phone:419-213-4208
Mailing Address - Fax:419-213-4232
Practice Address - Street 1:635 N ERIE ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-5317
Practice Address - Country:US
Practice Address - Phone:419-213-4208
Practice Address - Fax:419-213-4232
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.314187163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse