Provider Demographics
NPI:1144369711
Name:BORISH, LORRAINE M (NP)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:M
Last Name:BORISH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:MARIE
Other - Last Name:OUELLETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CNS
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-0001
Practice Address - Country:US
Practice Address - Phone:434-924-5219
Practice Address - Fax:434-924-9682
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001169010163W00000X
VA0024164330363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5000001028Medicare PIN
VAP52310Medicare UPIN