Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 008 | WY |
NPI | 1023382355 |
---|---|
Provider Name | Joanna Ballard |
First Address | Laramie, WY 82070 |
Second Address | Laramie, WY 82070-4307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2012 |
Last Update Date | 22/03/2017 |