Healthcare Provider Details

I. General information

NPI: 1639562630
Provider Name (Legal Business Name): ERIN ROSE BORNS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2015
Last Update Date: 11/14/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8303 DODGE STREET SUITE 250
OMAHA NE
68114
US

IV. Provider business mailing address

17445 ARBOR STREET SUITE 310
OMAHA NE
68130
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-8124
  • Fax: 402-354-8127
Mailing address:
  • Phone: 531-444-1206
  • Fax: 402-445-8033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1905
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: