1821052960 NPI number — KATHLEEN MARGARET BORER RN., LICSW

Table of content: KATHLEEN MARGARET BORER RN., LICSW (NPI 1821052960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821052960 NPI number — KATHLEEN MARGARET BORER RN., LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORER
Provider First Name:
KATHLEEN
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN., LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821052960
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2405 KALANIANAOLE ST PH 6
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILO
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96720-4905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-991-8237
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14730 COBALT ST NW UNIT 12
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAMSEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55303-3032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-991-8237
Provider Business Practice Location Address Fax Number:
207-512-1672
Provider Enumeration Date:
04/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  4091 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 16437 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1821052960 . This is a "BLUE CROSS BLUE SHIELD OF MINNESOTA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1821052960 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1821052960 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1821052960 . This is a "OPTUM" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 877621100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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