Provider Demographics
NPI:1265111553
Name:BORWEGE, NADINE (LDO)
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:BORWEGE
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21655 N LAKE PLEASANT PKWY
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-7436
Mailing Address - Country:US
Mailing Address - Phone:623-537-4595
Mailing Address - Fax:623-537-4972
Practice Address - Street 1:21655 N LAKE PLEASANT PKWY
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-7436
Practice Address - Country:US
Practice Address - Phone:623-537-4595
Practice Address - Fax:623-537-4972
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLDO-003133156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician