Provider Demographics
NPI:1427794841
Name:BORDERS, CHRISTIE MCCLOUD (CNS)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:MCCLOUD
Last Name:BORDERS
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4082 W ARDSLEY LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-9148
Mailing Address - Country:US
Mailing Address - Phone:812-320-3321
Mailing Address - Fax:
Practice Address - Street 1:4082 W ARDSLEY LN
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-9148
Practice Address - Country:US
Practice Address - Phone:812-320-3321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist