Provider Demographics
NPI:1356096614
Name:BORG, JENNI LEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JENNI
Middle Name:LEE
Last Name:BORG
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JENNI
Other - Middle Name:LEE
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4314 E 265 N
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-5148
Mailing Address - Country:US
Mailing Address - Phone:208-403-1318
Mailing Address - Fax:
Practice Address - Street 1:167 E 1ST S
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-1401
Practice Address - Country:US
Practice Address - Phone:208-745-8747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID71710363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily