Provider Demographics
NPI:1235517079
Name:BORDEAUX, DENNY (RN, PARAMEDIC)
Entity Type:Individual
Prefix:
First Name:DENNY
Middle Name:
Last Name:BORDEAUX
Suffix:
Gender:M
Credentials:RN, PARAMEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7294 DOWNING LANE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815
Mailing Address - Country:US
Mailing Address - Phone:208-416-8324
Mailing Address - Fax:
Practice Address - Street 1:7294 DOWNING LANE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815
Practice Address - Country:US
Practice Address - Phone:208-416-8324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID37139146L00000X
MTMED-PARA-LIC-33359146L00000X
OR130546146L00000X
WARN60455585163WF0300X
OR201140887RN163WF0300X
IDN-47481163WF0300X
MTNUR-RN-LIC-72952163WF0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WF0300XNursing Service ProvidersRegistered NurseFlight
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic