Provider Demographics
NPI:1225757156
Name:BOREN, BRIANNE ROSE (PA-C, RD, CNSC)
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:ROSE
Last Name:BOREN
Suffix:
Gender:F
Credentials:PA-C, RD, CNSC
Other - Prefix:
Other - First Name:BRIANNE
Other - Middle Name:BOREN
Other - Last Name:SHERWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CNSC
Mailing Address - Street 1:105 W 8TH AVE STE 6060
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2312
Mailing Address - Country:US
Mailing Address - Phone:509-838-4211
Mailing Address - Fax:
Practice Address - Street 1:105 W 8TH AVE STE 6060
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2312
Practice Address - Country:US
Practice Address - Phone:509-838-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA.PA.61488087363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant