Provider Demographics
NPI:1689631327
Name:BORDEN, SANDRA LEIGH (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LEIGH
Last Name:BORDEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 LA BARRE ST
Mailing Address - Street 2:PO BOX 6
Mailing Address - City:GIBBON
Mailing Address - State:NE
Mailing Address - Zip Code:68840
Mailing Address - Country:US
Mailing Address - Phone:717-202-0408
Mailing Address - Fax:
Practice Address - Street 1:1300 S LOCUST ST
Practice Address - Street 2:STE A
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801
Practice Address - Country:US
Practice Address - Phone:308-381-3800
Practice Address - Fax:308-381-4040
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110219363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47679417000Medicaid
MB0611651OtherDEA
277091Medicare ID - Type Unspecified
MB0611651OtherDEA