Individual
MRS. SHIRLEY BOROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N.
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
28093654A
IN
171M00000X
Case Manager/Care Coordinator
28093654A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100142050A
—
IN
Enumeration date
01/12/2012
Last updated
01/12/2012
Update your record
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