Provider Demographics
NPI:1932450392
Name:BORKOSKY, MARIANNE R (CNP)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:R
Last Name:BORKOSKY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 NAVARRE AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3435
Mailing Address - Country:US
Mailing Address - Phone:419-691-8132
Mailing Address - Fax:419-691-2061
Practice Address - Street 1:3841 NAVARRE AVE
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3435
Practice Address - Country:US
Practice Address - Phone:419-691-8132
Practice Address - Fax:419-691-2061
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.13846363LF0000X
OHCOA.13846-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0085454Medicaid