Provider Demographics
NPI:1033780275
Name:BORNMAN, STEVEN KELLY
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:KELLY
Last Name:BORNMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 CORTLANDT AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-3560
Mailing Address - Country:US
Mailing Address - Phone:419-203-0152
Mailing Address - Fax:
Practice Address - Street 1:636 CORTLANDT AVE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3560
Practice Address - Country:US
Practice Address - Phone:419-567-0059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty