Provider Demographics
NPI:1376852608
Name:BORGSTROM, CHRISTINE (FNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:BORGSTROM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:LAVIOLETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:3409 LUDINGTON ST STE 103
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-4213
Mailing Address - Country:US
Mailing Address - Phone:906-789-4040
Mailing Address - Fax:906-789-4044
Practice Address - Street 1:3409 LUDINGTON ST STE 103
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-4213
Practice Address - Country:US
Practice Address - Phone:906-789-4040
Practice Address - Fax:906-789-4044
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704221582363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0871266OtherBCBS OF MI
MI0871266OtherBCBS OF MI