Healthcare Provider Details

I. General information

NPI: 1639930076
Provider Name (Legal Business Name): DENISE BEATRICE BORDEAUX RN, MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 PICKETT LN
GREENFIELD MA
01301-9513
US

IV. Provider business mailing address

21 MOHAWK TR., PMB 261
GREENFIELD MA
01301
US

V. Phone/Fax

Practice location:
  • Phone: 413-768-8123
  • Fax:
Mailing address:
  • Phone: 413-768-8123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number187658
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2789
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: