Provider Demographics
NPI:1609569094
Name:BORG, DENISE LYNNE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:LYNNE
Last Name:BORG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 WADSWORTH RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2649
Mailing Address - Country:US
Mailing Address - Phone:330-321-9268
Mailing Address - Fax:
Practice Address - Street 1:816 WADSWORTH RD UNIT B
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2649
Practice Address - Country:US
Practice Address - Phone:330-321-9268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHJLP4363347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle