Provider Demographics
NPI:1093996837
Name:BALL, VICTORIA SUE (NP)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:SUE
Last Name:BALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:VICTORIA
Other - Middle Name:SUE
Other - Last Name:PIETRAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:501 LAPEER AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607
Mailing Address - Country:US
Mailing Address - Phone:989-759-6464
Mailing Address - Fax:989-399-8233
Practice Address - Street 1:3023 DAVENPORT AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-3652
Practice Address - Country:US
Practice Address - Phone:989-907-2761
Practice Address - Fax:989-907-2762
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704230298363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health