Active NPI
Diane H. Borneman, PSYCHOLOGIST
- Psychologist
- Nazareth, MI
National Provider Identifier
1619213774
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6301008718
- Practice address
- 3299 Gull Rd.
1St W 3Rd FL
Nazareth, MI 49074-0063 - Phone
- (269) 553-8060
- Fax
- (269) 553-8104
- NPI assigned
- Dec 18, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6301008718 | MI | Primary |
Addresses
Primary practice location
3299 Gull Rd.
1St W 3Rd FL
Nazareth, MI 49074-0063
Mailing address
84 S Lake Doster Dr
Plainwell, MI 49080-9109
Phone (269) 664-3066
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301008718 | MI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1355788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355788800000",
"number": "1619213774",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "84 S LAKE DOSTER DR",
"city": "PLAINWELL",
"state": "MI",
"postal_code": "490809109",
"telephone_number": "269-664-3066"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3299 GULL RD.",
"address_2": "1ST W 3RD FL",
"city": "NAZARETH",
"state": "MI",
"postal_code": "490740063",
"telephone_number": "269-553-8060",
"fax_number": "269-553-8104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORNEMAN",
"first_name": "DIANE",
"middle_name": "H.",
"name_prefix": "Ms.",
"credential": "PSYCHOLOGIST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-12-18",
"last_updated": "2012-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6301008718",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.