Provider Demographics
NPI:1891120762
Name:BORGERSEN, WENDY LYNN (CPNP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:LYNN
Last Name:BORGERSEN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:LYNN
Other - Last Name:OJEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3654 W ANTHEM WAY
Mailing Address - Street 2:SUITE B-114
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-0455
Mailing Address - Country:US
Mailing Address - Phone:623-551-0442
Mailing Address - Fax:623-551-0830
Practice Address - Street 1:3654 W ANTHEM WAY
Practice Address - Street 2:SUITE B-114
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-0455
Practice Address - Country:US
Practice Address - Phone:623-551-0442
Practice Address - Fax:623-551-0830
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5163363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ532459Medicaid
AZ1609879964OtherNPI (ELAINE SANTOS, MD)
1760594543OtherNPI (DAVID S. YIP, MD)
AZ577794Medicaid