Healthcare Provider Details

I. General information

NPI: 1013834316
Provider Name (Legal Business Name): NATHAN BORLEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 MARITIME DR
MANITOWOC WI
54220-2922
US

IV. Provider business mailing address

1020 MARITIME DR
MANITOWOC WI
54220-2922
US

V. Phone/Fax

Practice location:
  • Phone: 920-769-0152
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: