Provider Demographics
NPI:1518919521
Name:BORKGREN, MARILYN (APN, MS)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:BORKGREN
Suffix:
Gender:F
Credentials:APN, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BIESTERFIELD RD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3311
Mailing Address - Country:US
Mailing Address - Phone:847-981-3660
Mailing Address - Fax:847-956-5108
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:SUITE 510
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3311
Practice Address - Country:US
Practice Address - Phone:847-981-3660
Practice Address - Fax:847-956-5108
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001051364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01173148Medicare PIN
ILK23036Medicare PIN