Provider Demographics
NPI:1194529164
Name:BALLAH, CLARA K
Entity type:Individual
Prefix:MRS
First Name:CLARA
Middle Name:K
Last Name:BALLAH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:CLARA
Other - Middle Name:KOLU
Other - Last Name:BALLAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN/BSN
Mailing Address - Street 1:1848 39TH ST S APT 303
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4437
Mailing Address - Country:US
Mailing Address - Phone:701-405-3312
Mailing Address - Fax:
Practice Address - Street 1:1848 39TH ST S APT 303
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4437
Practice Address - Country:US
Practice Address - Phone:701-405-3312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR55333163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse