Provider Demographics
NPI:1164650339
Name:BORCHARDT, DONALD LEE (EDS)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:LEE
Last Name:BORCHARDT
Suffix:
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 W 4TH NORTH ST
Mailing Address - Street 2:
Mailing Address - City:GREEN RIVER
Mailing Address - State:WY
Mailing Address - Zip Code:82935-4037
Mailing Address - Country:US
Mailing Address - Phone:307-875-7420
Mailing Address - Fax:307-875-7420
Practice Address - Street 1:740 W 4TH NORTH ST
Practice Address - Street 2:
Practice Address - City:GREEN RIVER
Practice Address - State:WY
Practice Address - Zip Code:82935-4037
Practice Address - Country:US
Practice Address - Phone:307-875-7420
Practice Address - Fax:307-875-7420
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator