Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 60403 | MN |
NPI | 1033555370 |
---|---|
Provider Name | Dr. Amy Rebecca Borden |
First Address | Saint Paul, MN 55102-2346 |
Second Address | Saint Paul, MN 55102-2346 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2013 |
Last Update Date | 02/06/2016 |