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General NPI Number Information
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NPI Number | 1033424429
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Entity Type | Organization
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Legal Business Name | BORRON FAMILY MEDICINE PLLC
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Dates
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Enumeration Date | 08/10/2010
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Last Update Date | 02/28/2013
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Provider Practice Location Address
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Address Line | 790 W USTICK RD STE 110
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City | MERIDIAN
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State | ID
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Zip | 83646-5558
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Country | US
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Telephone | 208-639-3990
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Fax | 208-639-3992
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Provider Business Mailing Address
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Address Line | 790 W USTICK RD SUITE 110
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City | MERIDIAN
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State | ID
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Zip | 83646-5558
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Country | US
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Telephone | 208-639-3990
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Fax | 208-639-3992
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Authorized Official
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Title or Position | OWNER
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Name | BROOKNEY RAEANNE BORRON
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Credential | MSN, FNP-C
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Telephone | 208-866-1428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP-923A
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License Number State | ID
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