Provider Demographics
NPI:1679842330
Name:BORDEAUX, MARTHA SCHAUB (RNC, PNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:SCHAUB
Last Name:BORDEAUX
Suffix:
Gender:F
Credentials:RNC, PNP-BC
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Other - First Name:
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Mailing Address - Street 1:2424 ERWIN RD
Mailing Address - Street 2:SUITE 504, NEONATOLOGY
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3824
Mailing Address - Country:US
Mailing Address - Phone:919-970-7341
Mailing Address - Fax:919-681-6065
Practice Address - Street 1:5524 HOSPITAL N
Practice Address - Street 2:BOX 100500
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-970-7341
Practice Address - Fax:919-681-6065
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC300319363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal