Provider Demographics
NPI:1164700092
Name:BORGMAN, GENA MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:GENA
Middle Name:MARIE
Last Name:BORGMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:GENA
Other - Middle Name:MARIE
Other - Last Name:ROUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22 WESTFIELD AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401-1158
Mailing Address - Country:US
Mailing Address - Phone:203-308-2781
Mailing Address - Fax:
Practice Address - Street 1:22 WESTFIELD AVE STE 1
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-1158
Practice Address - Country:US
Practice Address - Phone:203-308-2781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8467363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily