Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | MATTI-0432-7278 | GA |
NPI | 1093855686 |
---|---|
Provider Name | Dr. Tamera Borchardt |
First Address | Dover Afb, DE 19902-5003 |
Second Address | Hurlburt Field, FL 32544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 17/07/2018 |