Healthcare Provider Details

I. General information

NPI: 1205913431
Provider Name (Legal Business Name): ADRIENNE MARY BORG N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 E 18TH AVE SUITE 12
EUGENE OR
97401-4081
US

IV. Provider business mailing address

74 E 18TH AVE SUITE 12
EUGENE OR
97401-4081
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-3330
  • Fax: 541-465-4785
Mailing address:
  • Phone: 541-686-3330
  • Fax: 541-465-4785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number691
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier050018
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: