Provider Demographics
NPI:1720523368
Name:BORDICK, MONICA (RN)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:BORDICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 CIRCLE RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6412
Mailing Address - Country:US
Mailing Address - Phone:410-303-4505
Mailing Address - Fax:
Practice Address - Street 1:1724 CIRCLE RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-6412
Practice Address - Country:US
Practice Address - Phone:410-303-4505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR214224163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health