Provider Demographics
NPI:1225999535
Name:BALLAYAN, AUDREY B
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:B
Last Name:BALLAYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 LAKESIDE DR APT 303
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68528-1793
Mailing Address - Country:US
Mailing Address - Phone:402-630-1275
Mailing Address - Fax:
Practice Address - Street 1:511 LAKESIDE DR APT 303
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68528-1793
Practice Address - Country:US
Practice Address - Phone:402-630-1275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-18
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion