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NPI Code Detail

MEDICARE: ERIK BORODEMOS MSN, APRN, PMHNP-BC

MEDICARE: ERIK BORODEMOS MSN, APRN, PMHNP-BC
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN04619RI
2163W00000XRegistered NurseRN55420RI

General Provider Information

NPI Number : 1750036471
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIK BORODEMOS MSN, APRN, PMHNP-BC
Provider Business Mailing Address
First Line : 520 HOPE ST
Second Line :
City : PROVIDENCE
State : RI
Zip : 02906-2532
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 520 HOPE ST
Second Line :
City : PROVIDENCE
State : RI
Zip : 02906-2532
Country : US
Telephone Number : 401-677-8545
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2022
Last Update Date : 01/23/2026

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