Provider Demographics
NPI:1235332479
Name:BORDEN, CATHERINE
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:BORDEN
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 1:4622 LOCK RD.
Mailing Address - Street 2:
Mailing Address - City:CENTERBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43011
Mailing Address - Country:US
Mailing Address - Phone:740-625-6419
Mailing Address - Fax:
Practice Address - Street 1:4622 LOCK RD.
Practice Address - Street 2:
Practice Address - City:CENTERBURG
Practice Address - State:OH
Practice Address - Zip Code:43011
Practice Address - Country:US
Practice Address - Phone:740-625-6419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN194729163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2706585Medicaid