Cheryl Denise Bordenave, RN
Individual provider Active NPI Registered Nurse · Lithonia, GA
NPI 1346690260 · NPPES record last updated Jun 21, 2016
Key facts
- NPI
- 1346690260
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- RN257907 (GA)
- Practice address
- 5321 Winding Glen Dr
Lithonia, GA 30038-2398 - Phone
- (678) 533-8633
- NPI assigned
- Jun 21, 2016
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN257907 | GA | MD | General Practice Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN257907 | GA | Yes |
| General Practice Registered Nurse | 163WG0000X | RN257907 | GA | |
| Home Health Registered Nurse | 163WH0200X | RN257907 | GA |
Addresses
Primary practice location
5321 Winding Glen Dr
Lithonia, GA 30038-2398
Mailing address
5321 Winding Glen Dr
Lithonia, GA 30038-2398
Phone (678) 533-8633
Other providers in Lithonia, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 21, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.