Provider Demographics
NPI:1326553454
Name:BORDEN, TRENT (RN, MBA, BSN)
Entity Type:Individual
Prefix:
First Name:TRENT
Middle Name:
Last Name:BORDEN
Suffix:
Gender:M
Credentials:RN, MBA, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 WEST RIDGELINE RD.
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:UT
Mailing Address - Zip Code:84071
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1530 WEST RIDGELINE RD.
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:UT
Practice Address - Zip Code:84071
Practice Address - Country:US
Practice Address - Phone:801-592-7482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT267430-3102163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health