Healthcare Provider Details

I. General information

NPI: 1588799332
Provider Name (Legal Business Name): PATRICIA ANN BORIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 CENTRAL AVE SUNY AT FREDONIA, LOGRASSO HALL HEALTH CENTER
FREDONIA NY
14063-1127
US

IV. Provider business mailing address

280 CENTRAL AVE SUNY AT FREDONIA, LOGRASSO HALL HEALTH CENTER
FREDONIA NY
14063-1127
US

V. Phone/Fax

Practice location:
  • Phone: 716-673-3131
  • Fax: 716-673-4722
Mailing address:
  • Phone: 716-673-3131
  • Fax: 716-673-4722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF330739-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: