Provider Demographics
NPI:1255309225
Name:BORDEN, ROBERTA M (CRNA MS APRN)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:M
Last Name:BORDEN
Suffix:
Gender:F
Credentials:CRNA MS APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 STAPLES LN
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-3924
Mailing Address - Country:US
Mailing Address - Phone:860-657-8598
Mailing Address - Fax:
Practice Address - Street 1:953 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-6014
Practice Address - Country:US
Practice Address - Phone:860-649-1550
Practice Address - Fax:860-649-1091
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036612367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered