Provider Demographics
NPI:1043867534
Name:BORINE, MORGAN (MA, MS, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:BORINE
Suffix:
Gender:F
Credentials:MA, MS, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 BIELENBERG DR STE 180
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1736
Mailing Address - Country:US
Mailing Address - Phone:612-225-4141
Mailing Address - Fax:
Practice Address - Street 1:576 BIELENBERG DR STE 180
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1736
Practice Address - Country:US
Practice Address - Phone:612-225-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6842363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health