Healthcare Provider Details

I. General information

NPI: 1265488530
Provider Name (Legal Business Name): BRANDEN M BORCHARDT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S. VAN DYKE
BAD AXE MI
48413-9615
US

IV. Provider business mailing address

1100 S. VAN DYKE
BAD AXE MI
48413-9615
US

V. Phone/Fax

Practice location:
  • Phone: 989-269-9521
  • Fax: 989-269-8922
Mailing address:
  • Phone: 989-269-9521
  • Fax: 989-269-8922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704212285
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: