Provider Demographics
NPI:1255626735
Name:BORGEN, KATHRYN (RD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BORGEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N ORANGE ST
Mailing Address - Street 2:207
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-2998
Mailing Address - Country:US
Mailing Address - Phone:406-721-4540
Mailing Address - Fax:
Practice Address - Street 1:900 N ORANGE ST
Practice Address - Street 2:207
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-2998
Practice Address - Country:US
Practice Address - Phone:406-721-4540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT591133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered