Provider Demographics
NPI:1780722009
Name:BORLAND, MARGO M (PMHCNS-PP)
Entity type:Individual
Prefix:
First Name:MARGO
Middle Name:M
Last Name:BORLAND
Suffix:
Gender:F
Credentials:PMHCNS-PP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 SE KANE ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-3943
Mailing Address - Country:US
Mailing Address - Phone:541-580-9899
Mailing Address - Fax:541-673-2270
Practice Address - Street 1:770 SE KANE ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3943
Practice Address - Country:US
Practice Address - Phone:541-580-9899
Practice Address - Fax:541-673-2270
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK662163WP0808X
OR200970008CNS-PP163WP0809X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500642555Medicaid
AKPENDINGMedicaid