Provider Demographics
NPI:1154565471
Name:BORDEAUX, RITA FAYE (RN)
Entity type:Individual
Prefix:MRS
First Name:RITA
Middle Name:FAYE
Last Name:BORDEAUX
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:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:MC LAUGHLIN
Mailing Address - State:SD
Mailing Address - Zip Code:57642-0061
Mailing Address - Country:US
Mailing Address - Phone:605-823-4278
Mailing Address - Fax:
Practice Address - Street 1:701 E. 6TH ST.
Practice Address - Street 2:BOX879
Practice Address - City:MCLAUGHLIN
Practice Address - State:SD
Practice Address - Zip Code:57642
Practice Address - Country:US
Practice Address - Phone:605-823-4458
Practice Address - Fax:605-823-4460
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR028436163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse