Provider Demographics
NPI:1962453894
Name:BORIS, JUDITH A (FNP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:BORIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 COLUMBUS AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-3701
Mailing Address - Country:US
Mailing Address - Phone:740-333-2236
Mailing Address - Fax:740-333-3881
Practice Address - Street 1:1510 COLUMBUS AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-1899
Practice Address - Country:US
Practice Address - Phone:740-333-3333
Practice Address - Fax:740-636-1196
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN231793 NP06492363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2254760Medicaid
OHP34573Medicare UPIN
H0096101Medicare PIN