Provider Demographics
NPI:1548321961
Name:BALLARD, LAURA ROSALIE
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ROSALIE
Last Name:BALLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:OLIVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 11867
Mailing Address - Street 2:CORRECTIONAL HEALTH DIVISION
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93775-1867
Mailing Address - Country:US
Mailing Address - Phone:559-600-3229
Mailing Address - Fax:559-445-2772
Practice Address - Street 1:1225 M ST
Practice Address - Street 2:CORRECTIONAL HEALTH, 2ND FLOOR
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1805
Practice Address - Country:US
Practice Address - Phone:559-442-2404
Practice Address - Fax:559-442-5277
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26874167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician