Provider Demographics
NPI:1245717263
Name:BORKOWSKI, KELLI (ARNP)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:BORKOWSKI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 N AVE
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442-7584
Mailing Address - Country:US
Mailing Address - Phone:712-263-3033
Mailing Address - Fax:712-263-3052
Practice Address - Street 1:101 2ND ST
Practice Address - Street 2:
Practice Address - City:IDA GROVE
Practice Address - State:IA
Practice Address - Zip Code:51445-1401
Practice Address - Country:US
Practice Address - Phone:712-364-2300
Practice Address - Fax:712-364-2881
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA124171363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner