Provider Demographics
NPI:1033665005
Name:BOREN, VICKI
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:BOREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 W OSAGE AVE
Mailing Address - Street 2:
Mailing Address - City:NOWATA
Mailing Address - State:OK
Mailing Address - Zip Code:74048-3331
Mailing Address - Country:US
Mailing Address - Phone:918-273-3425
Mailing Address - Fax:918-273-2105
Practice Address - Street 1:707 W OSAGE AVE
Practice Address - Street 2:
Practice Address - City:NOWATA
Practice Address - State:OK
Practice Address - Zip Code:74048-3331
Practice Address - Country:US
Practice Address - Phone:918-273-3425
Practice Address - Fax:918-273-2105
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant