MEDICARE: MARISA BORIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	28251465A	IN

General Provider Information

NPI Number	:	1740936962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA BORIS

Provider Business Mailing Address
First Line	:	4162 N COLLEGE AVE APT 2
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-2739
Country	:	US
Telephone Number	:	812-629-6103
Fax Number	:

Provider Business Practice Location Address
First Line	:	4162 N COLLEGE AVE APT 2
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-2739
Country	:	US
Telephone Number	:	812-629-6103
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2022
Last Update Date	:	02/25/2022

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Directions to “ MARISA BORIS ” Practice Location

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