Provider Demographics
NPI:1609077650
Name:BORDNER, RAYNEE H (LMP)
Entity Type:Individual
Prefix:
First Name:RAYNEE
Middle Name:H
Last Name:BORDNER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:SAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83860-0458
Mailing Address - Country:US
Mailing Address - Phone:206-818-5818
Mailing Address - Fax:
Practice Address - Street 1:17419 139TH AVE NE
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-8519
Practice Address - Country:US
Practice Address - Phone:206-818-5818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011925174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist