Provider Demographics
NPI:1922423243
Name:BORGGREEN, ALICIA AUDREY (LPN)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:AUDREY
Last Name:BORGGREEN
Suffix:
Gender:F
Credentials:LPN
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 43
Mailing Address - Street 2:
Mailing Address - City:SCHENEVUS
Mailing Address - State:NY
Mailing Address - Zip Code:12155-0043
Mailing Address - Country:US
Mailing Address - Phone:607-353-5742
Mailing Address - Fax:
Practice Address - Street 1:1772 COUNTY HIGHWAY 34
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:NY
Practice Address - Zip Code:13488-9602
Practice Address - Country:US
Practice Address - Phone:607-353-5742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3056771164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse