Provider Demographics
NPI:1194345868
Name:BALL, CHRISTINE LOUISE (RN)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:LOUISE
Last Name:BALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:LOUISE
Other - Last Name:BRONKEMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:6480 TECHNOLOGY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-8126
Mailing Address - Country:US
Mailing Address - Phone:269-250-8009
Mailing Address - Fax:877-326-2856
Practice Address - Street 1:6480 TECHNOLOGY AVE STE A
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-8126
Practice Address - Country:US
Practice Address - Phone:269-250-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704126834163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse