Healthcare Provider Details

I. General information

NPI: 1609710086
Provider Name (Legal Business Name): NATHAN LAMBERT BORGENICHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NATE BORGENICHT

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FOOTHILL BLVD BLDG 16
SALT LAKE CITY UT
84148-0001
US

IV. Provider business mailing address

500 FOOTHILL BLVD BLDG 16
SALT LAKE CITY UT
84148-0001
US

V. Phone/Fax

Practice location:
  • Phone: 801-582-1565
  • Fax: 801-584-2544
Mailing address:
  • Phone: 801-582-1565
  • Fax: 801-584-2544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number11767196-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number11767196-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: