Provider Demographics
NPI:1730901257
Name:BORDSEN, CLARA ANN
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:ANN
Last Name:BORDSEN
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 1:1960 EDGERTON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2112
Mailing Address - Country:US
Mailing Address - Phone:651-497-8022
Mailing Address - Fax:
Practice Address - Street 1:601 W DAYTON ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1206
Practice Address - Country:US
Practice Address - Phone:651-497-8022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program