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NPI Code Detail

MEDICARE: KELBY BORCHGREVINK

MEDICARE: KELBY BORCHGREVINK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant63438CA

General Provider Information

NPI Number : 1023530219
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELBY BORCHGREVINK
Provider Business Mailing Address
First Line : 4908 BRAHMA ST
Second Line :
City : GILLETTE
State : WY
Zip : 82718-8503
Country : US
Telephone Number : 307-257-3417
Fax Number :
Provider Business Practice Location Address
First Line : 3425 N 1ST ST
Second Line :
City : FRESNO
State : CA
Zip : 93726-6821
Country : US
Telephone Number : 559-608-6581
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2017
Last Update Date : 12/18/2023

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Directions to “ KELBY BORCHGREVINK ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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