Healthcare Provider Details

I. General information

NPI: 1942649322
Provider Name (Legal Business Name): MARY HELEN BORCK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 UNITED PLAZA BLVD SUITE 702
BATON ROUGE LA
70809-2256
US

IV. Provider business mailing address

2 CARLSON PKWY N SUITE 401
PLYMOUTH MN
55447-4466
US

V. Phone/Fax

Practice location:
  • Phone: 855-482-6237
  • Fax:
Mailing address:
  • Phone: 855-482-6237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN086802
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: