Provider Demographics
NPI:1255721841
Name:BORST, DONALD JOHN (RN)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:JOHN
Last Name:BORST
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 CLYMER SHERMAN RD
Mailing Address - Street 2:
Mailing Address - City:CLYMER
Mailing Address - State:NY
Mailing Address - Zip Code:14724-9756
Mailing Address - Country:US
Mailing Address - Phone:716-355-4378
Mailing Address - Fax:
Practice Address - Street 1:1116 CLYMER SHERMAN RD
Practice Address - Street 2:
Practice Address - City:CLYMER
Practice Address - State:NY
Practice Address - Zip Code:14724-9756
Practice Address - Country:US
Practice Address - Phone:716-355-4378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302903163W00000X
PARN244092L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse