Provider Demographics
NPI:1487535134
Name:MCDONALD- BORUM, TAKIA
Entity type:Individual
Prefix:MRS
First Name:TAKIA
Middle Name:
Last Name:MCDONALD- BORUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19530 CHAD HITTLE DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-3836
Mailing Address - Country:US
Mailing Address - Phone:317-660-5156
Mailing Address - Fax:
Practice Address - Street 1:19530 CHAD HITTLE DR APT 158
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-3841
Practice Address - Country:US
Practice Address - Phone:317-660-5156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN25-019200-13747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant