Individual
BLAYNE BORDWINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1200 CHILDRENS AVE, OKLAHOMA CITY, OK 73104-4637
(405) 271-4700
Mailing address
12721 NW 137TH ST, PIEDMONT, OK 73078-8149
Taxonomy
Speciality
Code
Description
License number
State
2080H0002X
Pediatric Hospice and Palliative Medicine Physician
Primary
215424
OK
363LP0222X
Critical Care Pediatric Nurse Practitioner
215424
OK
Other
Enumeration date
10/02/2023
Last updated
12/18/2024
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