Provider Demographics
NPI:1699541417
Name:BORJON, IVONNE C (RN, PHN)
Entity type:Individual
Prefix:
First Name:IVONNE
Middle Name:C
Last Name:BORJON
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 HUMBOLDT ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4214
Mailing Address - Country:US
Mailing Address - Phone:707-657-9464
Mailing Address - Fax:
Practice Address - Street 1:415 HUMBOLDT ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4214
Practice Address - Country:US
Practice Address - Phone:707-657-9464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA563151163WC1500X
CA95187358163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health