Provider Demographics
NPI:1144730458
Name:DAISY BORDERS, BRYN HAYES
Entity type:Individual
Prefix:
First Name:BRYN
Middle Name:HAYES
Last Name:DAISY BORDERS
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 1:700 WEST AVE S
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4783
Mailing Address - Country:US
Mailing Address - Phone:608-785-0940
Mailing Address - Fax:
Practice Address - Street 1:4050 LAKE OTIS PKWY STE 208
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5221
Practice Address - Country:US
Practice Address - Phone:907-885-0206
Practice Address - Fax:907-600-5089
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8020-33367500000X
AK134308367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered