MEDICARE: MR. ROBERT LEE BORDELON III APRN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN095750 AP06670	LA

General Provider Information

NPI Number	:	1154755460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT LEE BORDELON III APRN, FNP-C

Provider Business Mailing Address
First Line	:	4045 SCENIC HWY
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70805-4860
Country	:	US
Telephone Number	:	225-977-6440
Fax Number	:	225-977-6342

Provider Business Practice Location Address
First Line	:	4045 SCENIC HWY
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70805-4860
Country	:	US
Telephone Number	:	225-977-6440
Fax Number	:	225-977-6342

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2013
Last Update Date	:	08/23/2013

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