Provider Demographics
NPI:1497180707
Name:BORKIEWICZ, DOROTA (NP)
Entity Type:Individual
Prefix:
First Name:DOROTA
Middle Name:
Last Name:BORKIEWICZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DOROTA
Other - Middle Name:
Other - Last Name:KUKLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:10 ANDREW SQ STE 102
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-3037
Mailing Address - Country:US
Mailing Address - Phone:617-313-7360
Mailing Address - Fax:
Practice Address - Street 1:10 ANDREW SQ STE 102
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-3037
Practice Address - Country:US
Practice Address - Phone:176-313-7360
Practice Address - Fax:617-404-2097
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2313806363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health