Provider Demographics
NPI:1457939001
Name:BORUM, DANEEDA C
Entity Type:Individual
Prefix:
First Name:DANEEDA
Middle Name:C
Last Name:BORUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1291 BRENTWOOD RD NE APT 1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-1030
Mailing Address - Country:US
Mailing Address - Phone:202-706-1588
Mailing Address - Fax:
Practice Address - Street 1:1291 BRENTWOOD RD NE APT 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1030
Practice Address - Country:US
Practice Address - Phone:202-706-1588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant