Individual
MRS. ANNA MARIE BORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2031 CHARLES ST, RACINE, WI 53402-4609
(262) 637-5302
Mailing address
2031 CHARLES ST, RACINE, WI 53402-4609
(262) 637-5302
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
304505-31
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
164 W00000X
TAX NUMBER
WI
Enumeration date
09/09/2011
Last updated
09/09/2011
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