Healthcare Provider Details

I. General information

NPI: 1396909826
Provider Name (Legal Business Name): NOREEN ELLEN BORINO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLEN NOREEN WALL

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 E FOREMASTER DR STE 360
ST GEORGE UT
84790-4508
US

IV. Provider business mailing address

1490 E FOREMASTER DR STE 360
ST GEORGE UT
84790-4508
US

V. Phone/Fax

Practice location:
  • Phone: 435-359-3115
  • Fax: 435-291-1096
Mailing address:
  • Phone: 435-359-3115
  • Fax: 435-291-1096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11644569-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAPN223
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN00223
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: