Healthcare Provider Details

I. General information

NPI: 1427938711
Provider Name (Legal Business Name): NICOLE BORJON RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 S DAMEN AVE
CHICAGO IL
60612-3727
US

IV. Provider business mailing address

432 DRIFTWOOD DR
DEKALB IL
60115-1878
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-7800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number041483090
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: