Most Relevant Information
Provider Data
| NPI Number: | 1003054586 |
| Provider Name: | MICHELE MARIE BALLISTER DNP APRN CRNA CHSE |
| Entity Type: | Individual |
| Taxonomy Code: | 367500000X |
| Specialty: | Nurse Anesthetist, Certified Registered |
| License Number: | 289363 |
Most Important Dates
| Enumeration Date: | 01/22/2009 |
| Last Updated: | 04/29/2024 |
Provider Practice Location
1514 VERNON RD
LAGRANGE
GA
302404131
Practice Location Phone/Fax
| Phone: | 7068221411 |
| Fax: |
Provider Mailing Location
PO BOX 603484
CHARLOTTE
NC
282603484
Provider Mailing Phone/Fax
| Phone: | 8037651838 |
| Fax: | 8037651732 |