Provider Demographics
NPI:1528023496
Name:BALL, SHARON (APNC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:BALL
Suffix:
Gender:F
Credentials:APNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 577
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-0577
Mailing Address - Country:US
Mailing Address - Phone:618-985-8221
Mailing Address - Fax:618-985-6860
Practice Address - Street 1:201 SOUTH 14TH ST.
Practice Address - Street 2:HERRIN HOSPITAL RESPIRATORY DISEASE CLINIC
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948
Practice Address - Country:US
Practice Address - Phone:618-942-2171
Practice Address - Fax:618-351-4945
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005527363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL370966854016Medicaid
ILCF3444OtherMEDICARE RAILROAD GROUP
IL640701Medicare Oscar/Certification
IL370966854016Medicaid
IL141021Medicare Oscar/Certification