Healthcare Provider Details

I. General information

NPI: 1447537725
Provider Name (Legal Business Name): RACHEL L BORES STNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S MAIN ST
MONROEVILLE OH
44847-9792
US

IV. Provider business mailing address

107 S MAIN ST
MONROEVILLE OH
44847-9792
US

V. Phone/Fax

Practice location:
  • Phone: 216-374-1806
  • Fax:
Mailing address:
  • Phone: 216-374-1806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number401228380411
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: