Provider Demographics
NPI:1548495724
Name:BALLARD, CHARLOTTE D (RNFA)
Entity type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:D
Last Name:BALLARD
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:MS
Other - First Name:CHARLOTTE
Other - Middle Name:D
Other - Last Name:BALLARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RNFA
Mailing Address - Street 1:1201 S. MILLER STREET
Mailing Address - Street 2:CENTRAL WASHINGTON HOSPITAL
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-3201
Mailing Address - Country:US
Mailing Address - Phone:509-665-6054
Mailing Address - Fax:509-665-6052
Practice Address - Street 1:1201 S MILLER ST
Practice Address - Street 2:CENTRAL WASHINGTON HOSPITAL
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-3201
Practice Address - Country:US
Practice Address - Phone:509-665-6054
Practice Address - Fax:509-665-6052
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00163965163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0281111OtherL&I