Provider Demographics
NPI:1376804005
Name:BORGWARDT, KELLI MICHELE (NP)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:MICHELE
Last Name:BORGWARDT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2201 W FAIRVIEW ST
Mailing Address - Street 2:STE 1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4712
Mailing Address - Country:US
Mailing Address - Phone:480-800-4890
Mailing Address - Fax:480-427-4766
Practice Address - Street 1:655 S DOBSON RD
Practice Address - Street 2:BUILDING A, SUITE 103
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5667
Practice Address - Country:US
Practice Address - Phone:480-917-3706
Practice Address - Fax:480-917-3756
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2016-09-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZRN147478363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health