Mary Kathleen Bornick, LICENSE PRACTICAL NU

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

13474-031 Issued in WI

Practice address

W. 6143 N. Thornapple Court
Fort Atkinson, WI 53538

Phone

(920) 563-2359

NPI assigned

Apr 30, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1241049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1241049600000",
    "number": "1306080551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W. 6143 N. THORNAPPLE COURT",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "53538",
            "telephone_number": "920-563-2359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W. 6143 N. THORNAPPLE COURT",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "53538",
            "telephone_number": "920-563-2359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORNICK",
        "first_name": "MARY",
        "middle_name": "KATHLEEN",
        "name_prefix": "Mrs.",
        "credential": "LICENSE PRACTICAL NU",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-04-30",
        "last_updated": "2009-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "WI",
            "license": "13474-031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas J Bisenius, PHD
• Ryann Bixler, RDH
• Sherry Bleecker, LPN
• Matthew S Bliss, MD
• Ernesto Bogarin Miranda, M.D.
• Kathleen Karen Brandt, RN
• Scott J Brantmeier, DO
• Jacob Alan Braun, DPT
• Bridget Piller
• Barbara L Brouwer, LAC

• Licensed Practical Nurse in Fort Atkinson, WI
• Providers in Fort Atkinson, WI by specialty
• Licensed Practical Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.