Provider Demographics
NPI:1083656631
Name:BORDAS, CARL (CRNA)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:BORDAS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01101-1330
Mailing Address - Country:US
Mailing Address - Phone:413-796-7494
Mailing Address - Fax:413-796-7498
Practice Address - Street 1:908 ALLEN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-2533
Practice Address - Country:US
Practice Address - Phone:413-796-7494
Practice Address - Fax:413-796-7498
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA179567367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered