Basic Information
| Provider Information | |||||||||
| NPI: | 1356394282 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BORG | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 537 | ||||||||
| Address2: | |||||||||
| City: | SKAGWAY | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998400537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9079832255 | ||||||||
| FaxNumber: | 9079832793 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 14TH AVE | ||||||||
| Address2: | |||||||||
| City: | SKAGWAY | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998400537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9079832255 | ||||||||
| FaxNumber: | 9079832793 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 08/04/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R024086 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 3475 | 01 | SD | DAKOTACARE | OTHER | 6825703 | 05 | SD | MEDICAID | NP0019 | 05 | AK | MEDICAID | 0004772 | 01 | SD | WELLMARK | OTHER | 0004792 | 01 | SD | WELLMARK | OTHER | 9239542 | 01 | SD | DAKOTACARE | OTHER | P00352245 | 01 | SD | RR MEDICARE | OTHER | 6825704 | 05 | SD | MEDICAID |