Provider Demographics
NPI:1154078517
Name:BORG, DANIELLE (APRN)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BORG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:BOYLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:2400 E CATALINA DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3911
Mailing Address - Country:US
Mailing Address - Phone:801-842-9593
Mailing Address - Fax:
Practice Address - Street 1:2400 E CATALINA DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-3911
Practice Address - Country:US
Practice Address - Phone:801-842-9593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-06
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT98146164450363L00000X
UT9814616-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner