Provider Demographics
NPI:1376369843
Name:BORCHERT, BETHANY KAY (BSN)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:KAY
Last Name:BORCHERT
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5039 160TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:ND
Mailing Address - Zip Code:58021-9770
Mailing Address - Country:US
Mailing Address - Phone:701-840-8493
Mailing Address - Fax:
Practice Address - Street 1:2101 ELM ST N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2417
Practice Address - Country:US
Practice Address - Phone:701-239-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR32507163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation