Basic Information
| Provider Information | |||||||||
| NPI: | 1184089229 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOROS | ||||||||
| FirstName: | MARILYN | ||||||||
| MiddleName: | JANE | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16110 DETROIT AVENUE | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162287878 | ||||||||
| FaxNumber: | 2165295051 | ||||||||
| Practice Location | |||||||||
| Address1: | 16110 DETROIT AVE | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441073715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162287878 | ||||||||
| FaxNumber: | 2165295051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2015 | ||||||||
| LastUpdateDate: | 12/16/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | COA.18216-NP | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.