Provider Demographics
NPI:1073016044
Name:BORISH, ELLEN THERESA
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:THERESA
Last Name:BORISH
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 1:532 CRANBROOK DR
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-4235
Mailing Address - Country:US
Mailing Address - Phone:817-320-8140
Mailing Address - Fax:
Practice Address - Street 1:532 CRANBROOK DR
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76131-4235
Practice Address - Country:US
Practice Address - Phone:817-320-8140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX183841164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse