Provider Demographics
NPI:1154958130
Name:BALL, LONNELE (BS, MS, PHD)
Entity type:Individual
Prefix:DR
First Name:LONNELE
Middle Name:
Last Name:BALL
Suffix:
Gender:F
Credentials:BS, MS, PHD
Other - Prefix:
Other - First Name:LONNELE
Other - Middle Name:
Other - Last Name:BALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:69 NORTHAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-1714
Mailing Address - Country:US
Mailing Address - Phone:415-521-9615
Mailing Address - Fax:
Practice Address - Street 1:69 NORTHAMPTON AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-1714
Practice Address - Country:US
Practice Address - Phone:415-521-9615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education