1154651636 NPI number — KAREN L BORICH RN, MSN, CPNP

Table of content: KAREN L BORICH RN, MSN, CPNP (NPI 1154651636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154651636 NPI number — KAREN L BORICH RN, MSN, CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORICH
Provider First Name:
KAREN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, MSN, CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SABO
Provider Other First Name:
KAREN
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, MSN, CPNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154651636
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1810 KENWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78704-3632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1807 WEST SLAUGHTER LANE
Provider Second Line Business Practice Location Address:
SUITE 490
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78748-3632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-282-8967
Provider Business Practice Location Address Fax Number:
512-292-5143
Provider Enumeration Date:
01/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  642105 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 210407701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 642105 . This is a "RN LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 210407702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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