Provider Demographics
NPI:1053977496
Name:BOROFF, HEIDI NICOLE (RN)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:NICOLE
Last Name:BOROFF
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6705 N STATE LINE RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46797-9736
Mailing Address - Country:US
Mailing Address - Phone:260-417-5514
Mailing Address - Fax:
Practice Address - Street 1:6705 N STATE LINE RD
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:IN
Practice Address - Zip Code:46797-9736
Practice Address - Country:US
Practice Address - Phone:260-417-5514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28210318A163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice