Provider Demographics
NPI:1659311033
Name:BORGEN, MELISSA F (CRNA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:F
Last Name:BORGEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:3000 32ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6132
Practice Address - Country:US
Practice Address - Phone:701-364-8000
Practice Address - Fax:701-364-8078
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR22112367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND967141OtherARAZ #
ND3786OtherNDBS #
ND2000777OtherMEDICA INNOVIS #
NDDA9011015510OtherPREF 1 #
NDHP38619OtherHEALTHPARTNERS #
ND482216100Medicaid
ND12684Medicaid
ND3T746KROtherMNBS FGO #
ND967141OtherARAZ #
ND482216100Medicaid
NDHP38619OtherHEALTHPARTNERS #
ND12684Medicaid