Provider Demographics
NPI:1154755460
Name:BORDELON, ROBERT LEE III (APRN, FNP-C)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LEE
Last Name:BORDELON
Suffix:III
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4045 SCENIC HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-4860
Mailing Address - Country:US
Mailing Address - Phone:225-977-6440
Mailing Address - Fax:225-977-6342
Practice Address - Street 1:4045 SCENIC HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-4860
Practice Address - Country:US
Practice Address - Phone:225-977-6440
Practice Address - Fax:225-977-6342
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN095750 AP06670363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily