Individual
MRS. BARBRA ANN BORDEAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
3200 CANYON LAKE DR, RAPID CITY, SD 57702-8114
(605) 355-2500
(605) 355-2553
Mailing address
3200 CANYON LAKE DR, RAPID CITY, SD 57702-8114
(605) 355-2500
(605) 355-2553
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R032559
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0140070
MEDCAID INPATIENT
SD
05
—
5549050
—
SD
Enumeration date
12/16/2009
Last updated
12/16/2009
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