Provider Demographics
NPI:1700671047
Name:BALLS, DEENA (CNM)
Entity type:Individual
Prefix:
First Name:DEENA
Middle Name:
Last Name:BALLS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 76
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:UT
Mailing Address - Zip Code:84305-0076
Mailing Address - Country:US
Mailing Address - Phone:435-512-4747
Mailing Address - Fax:435-512-4747
Practice Address - Street 1:2245 N 400 E STE 201
Practice Address - Street 2:
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-1891
Practice Address - Country:US
Practice Address - Phone:435-787-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9039254-4402176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife