Provider Demographics
NPI:1356394282
Name:BORG, CAROL J (CNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:BORG
Suffix:
Gender:F
Credentials:CNP
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 537
Mailing Address - Street 2:
Mailing Address - City:SKAGWAY
Mailing Address - State:AK
Mailing Address - Zip Code:99840-0537
Mailing Address - Country:US
Mailing Address - Phone:907-983-2255
Mailing Address - Fax:907-983-2793
Practice Address - Street 1:350 14TH AVE
Practice Address - Street 2:
Practice Address - City:SKAGWAY
Practice Address - State:AK
Practice Address - Zip Code:99840-0537
Practice Address - Country:US
Practice Address - Phone:907-983-2255
Practice Address - Fax:907-983-2793
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR024086363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD3475OtherDAKOTACARE
SD6825703Medicaid
AKNP0019Medicaid
SD0004772OtherWELLMARK
SD0004792OtherWELLMARK
SD9239542OtherDAKOTACARE
SDP00352245OtherRR MEDICARE
SD6825704Medicaid
SDS101107Medicare PIN
SD0004772OtherWELLMARK
SD6825704Medicaid
SD0004792OtherWELLMARK
SDS101278Medicare PIN