Healthcare Provider Details

I. General information

NPI: 1215072202
Provider Name (Legal Business Name): JOHN MICHAEL BORZA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W GREENLAWN AVE
LANSING MI
48910-2819
US

IV. Provider business mailing address

1264 WOODHILL DR
GIBSONIA PA
15044-9277
US

V. Phone/Fax

Practice location:
  • Phone: 517-334-2121
  • Fax:
Mailing address:
  • Phone: 724-444-6276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704184059
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: