Provider Demographics
NPI:1649679473
Name:BOORSMA, DANAE (CNP, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:DANAE
Middle Name:
Last Name:BOORSMA
Suffix:
Gender:F
Credentials:CNP, FNP-BC
Other - Prefix:
Other - First Name:DANAE
Other - Middle Name:
Other - Last Name:ROE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:106 LATHAM ST.
Mailing Address - Street 2:
Mailing Address - City:BROWNSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55918
Mailing Address - Country:US
Mailing Address - Phone:507-259-2345
Mailing Address - Fax:
Practice Address - Street 1:308 4TH AVE NW
Practice Address - Street 2:STE 4
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912
Practice Address - Country:US
Practice Address - Phone:507-279-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2024-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ273793363L00000X
CA95001127363LF0000X
NY350609363LF0000X
MN11556363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95001127OtherNURSE PRACTITIONER LICENSE
AZ273793OtherNURSE PRACTITIONER LICENSE
MN115566OtherNURSE PRACTITIONER LICENSE
NY350609OtherNURSE PRACTITIONER LICENSE