MEDICARE: SAVANNA C BORNE FNP

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
1	163W00000X	Registered Nurse	R090803-4	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	H400116212	OTHER	MN	MEDICARE NGS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R0908034	OTHER	MN	MINNESOTA MEDICAL LICENSE

General Provider Information

NPI Number	:	1386832103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVANNA C BORNE FNP

Provider Business Mailing Address
First Line	:	720 WASHINGTON AVE SE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55414-2924
Country	:	US
Telephone Number	:	763-782-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 WASHINGTON AVE SE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55414-2924
Country	:	US
Telephone Number	:	763-782-6400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	02/28/2014

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