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Christa Ruble Balanoff

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NPI Number Detailed Information

Provider Information:

Name: Christa Ruble Balanoff
Gender: F
Provider License Number If Given: 04-31985

NPI Information:

NPI: 1659370161
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 7/18/2005

Last Update Date: 11/25/2014

Provider Business Mailing Address:

Address: 10787 NALL AVE SUITE 220
Overland Park, KS 66211
Phone Number: 9139459400
Fax Number: 9139459410

Provider Business Practice Location Address:

Address: 10787 NALL AVE SUITE 220
Overland Park, KS 66211
Phone Number: 9139459400
Fax Number: 9139459410

Provider Taxonomy:

Primary: 208600000X
Secondary (if any): 208600000X
State: KS

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