Provider Demographics
NPI:1912937343
Name:BORUNDA, LISA ANN (C-FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:BORUNDA
Suffix:
Gender:F
Credentials:C-FNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:RONDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:C-FNP
Mailing Address - Street 1:295 S 1470 E STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-1762
Mailing Address - Country:US
Mailing Address - Phone:435-674-0999
Mailing Address - Fax:435-674-0960
Practice Address - Street 1:295 S 1470 E STE 300
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-1762
Practice Address - Country:US
Practice Address - Phone:435-674-0999
Practice Address - Fax:435-674-0960
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1939514405363LX0001X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTQ02521Medicare UPIN