Provider Demographics
NPI:1699582213
Name:BALL-WILLIS, JOEANNA
Entity type:Individual
Prefix:
First Name:JOEANNA
Middle Name:
Last Name:BALL-WILLIS
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 1:4603 JAYNES ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-1454
Mailing Address - Country:US
Mailing Address - Phone:402-676-5730
Mailing Address - Fax:
Practice Address - Street 1:4603 JAYNES ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-1454
Practice Address - Country:US
Practice Address - Phone:402-676-5730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant