Provider Demographics
NPI:1316990021
Name:BORMAN, NANCY LYNNE (DO)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:LYNNE
Last Name:BORMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:LYNNE
Other - Last Name:SAYLORS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1585 SW MARLOW AVE.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5178
Mailing Address - Country:US
Mailing Address - Phone:503-548-4008
Mailing Address - Fax:971-266-8251
Practice Address - Street 1:1585SWMARLOW AVE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5178
Practice Address - Country:US
Practice Address - Phone:503-548-4008
Practice Address - Fax:971-266-8251
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO19719207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E83578Medicare UPIN