Provider Demographics
NPI:1740366780
Name:BORN, CATTLEYA MARIE (RNC)
Entity type:Individual
Prefix:MRS
First Name:CATTLEYA
Middle Name:MARIE
Last Name:BORN
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6743 BRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-1298
Mailing Address - Country:US
Mailing Address - Phone:706-321-9007
Mailing Address - Fax:
Practice Address - Street 1:MARTIN ARMY COMMUNITY HOSPITAL
Practice Address - Street 2:
Practice Address - City:FT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905-5637
Practice Address - Country:US
Practice Address - Phone:706-544-2463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704208170163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn