Provider Demographics
NPI:1679219992
Name:BORCHERS, BEVERLY HALL
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:HALL
Last Name:BORCHERS
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 1:96 MAYERS TRCE
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-3298
Mailing Address - Country:US
Mailing Address - Phone:985-774-4890
Mailing Address - Fax:
Practice Address - Street 1:259 BRAKEFIELD ST
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-3617
Practice Address - Country:US
Practice Address - Phone:985-643-5166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1034549163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0200XNursing Service ProvidersRegistered NursePediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA01102022Medicaid