MEDICARE: MRS. PATRICIA ANN BORIS NP

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	F330739-1	NY

General Provider Information

NPI Number	:	1588799332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA ANN BORIS NP

Provider Business Mailing Address
First Line	:	280 CENTRAL AVE
Second Line	:	SUNY AT FREDONIA, LOGRASSO HALL HEALTH CENTER
City	:	FREDONIA
State	:	NY
Zip	:	14063-1127
Country	:	US
Telephone Number	:	716-673-3131
Fax Number	:	716-673-4722

Provider Business Practice Location Address
First Line	:	280 CENTRAL AVE
Second Line	:	SUNY AT FREDONIA, LOGRASSO HALL HEALTH CENTER
City	:	FREDONIA
State	:	NY
Zip	:	14063-1127
Country	:	US
Telephone Number	:	716-673-3131
Fax Number	:	716-673-4722

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	07/08/2007

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