Provider Demographics
NPI:1639562630
Name:BORNS, ERIN ROSE (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:ROSE
Last Name:BORNS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19164 DREXEL CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-1840
Mailing Address - Country:US
Mailing Address - Phone:605-359-2480
Mailing Address - Fax:
Practice Address - Street 1:555 FORTUNE DR
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-3421
Practice Address - Country:US
Practice Address - Phone:402-502-3600
Practice Address - Fax:402-502-3606
Is Sole Proprietor?:No
Enumeration Date:2015-03-15
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1905363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant