Basic Information
| Provider Information | |||||||||
| NPI: | 1790260164 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BORMAN | ||||||||
| FirstName: | BRANDY | ||||||||
| MiddleName: | LAUREN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1861 POWDER MILL ROAD | ||||||||
| Address2: | ATTN MEDICAL STAFF OFFICE | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174024723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177182041 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1861 POWDER MILL RD | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174024723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177182000 | ||||||||
| FaxNumber: | 7177183460 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2018 | ||||||||
| LastUpdateDate: | 04/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP019343 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.