Individual
TONI ANNETTE BORK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1057 PAUL MAILLARD RD, LULING, LA 70070-4349
(985) 785-6242
Mailing address
1057 PAUL MAILLARD RD, LULING, LA 70070-4349
(985) 785-6242
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP02316
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07708077
—
MS
05
—
1657662
—
LA
Enumeration date
06/17/2006
Last updated
05/25/2016
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