Provider Demographics
NPI:1215222898
Name:BORGESTAD, MISTI LEE (FNP, CNM)
Entity Type:Individual
Prefix:
First Name:MISTI
Middle Name:LEE
Last Name:BORGESTAD
Suffix:
Gender:F
Credentials:FNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 HOSPITAL DR STE 270
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3244
Mailing Address - Country:US
Mailing Address - Phone:843-818-1123
Mailing Address - Fax:
Practice Address - Street 1:1300 HOSPITAL DR STE 270
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3244
Practice Address - Country:US
Practice Address - Phone:843-818-1123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016708363LF0000X
IAA-126661363LF0000X
CA236175367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1215222898Medicaid
IA719260001Medicare PIN