Provider Demographics
NPI:1518040237
Name:BALL, JEAN MARIE (FNP)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:BALL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:360 US HIGHWAY 1 BYP UNIT 102
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7105
Mailing Address - Country:US
Mailing Address - Phone:603-410-6700
Mailing Address - Fax:603-319-8308
Practice Address - Street 1:506 MAIN ST
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1530
Practice Address - Country:US
Practice Address - Phone:207-571-7991
Practice Address - Fax:207-571-7990
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2024-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME050380 COMPACT363LF0000X
NH044880-23363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3077354Medicaid