Provider Demographics
NPI:1669071403
Name:BORGEN, SANDRA JEAN (CNA)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:BORGEN
Suffix:
Gender:F
Credentials:CNA
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 189
Mailing Address - Street 2:
Mailing Address - City:LIDGERWOOD
Mailing Address - State:ND
Mailing Address - Zip Code:58053-0189
Mailing Address - Country:US
Mailing Address - Phone:701-403-0104
Mailing Address - Fax:
Practice Address - Street 1:110 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:LIDGERWOOD
Practice Address - State:ND
Practice Address - Zip Code:58053-4200
Practice Address - Country:US
Practice Address - Phone:701-403-0104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant