Provider Demographics
NPI:1962075572
Name:BASIR BALLA, NASR (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:NASR
Middle Name:
Last Name:BASIR BALLA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E BROADWAY STE 214
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-2812
Mailing Address - Country:US
Mailing Address - Phone:804-687-5601
Mailing Address - Fax:
Practice Address - Street 1:320 E BROADWAY STE 214
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-2812
Practice Address - Country:US
Practice Address - Phone:804-687-5601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00024182223363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health