Healthcare Provider Details

I. General information

NPI: 1407205511
Provider Name (Legal Business Name): NADIA BORBONI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N WEST AVE STE 300
JACKSON MI
49202-2180
US

IV. Provider business mailing address

12640 CALHOUN RD
JEROME MI
49249-9827
US

V. Phone/Fax

Practice location:
  • Phone: 517-789-1234
  • Fax:
Mailing address:
  • Phone: 586-260-3781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: