Healthcare Provider Details

I. General information

NPI: 1356171979
Provider Name (Legal Business Name): DANIA VIESCA BORUNDA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIA BORUNDA RN

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 NE 10TH ST # 2100
OKLAHOMA CITY OK
73104-5418
US

IV. Provider business mailing address

1201 N EUNICE AVE
NEWCASTLE OK
73065-4050
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-8707
  • Fax: 405-271-2976
Mailing address:
  • Phone: 405-476-0007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR0087245
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: