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General NPI Number Information
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NPI Number | 1780313478
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Entity Type | Organization
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Legal Business Name | SUSAN BORDEN PSYCH
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Dates
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Enumeration Date | 06/08/2022
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 2303 WYCLIFF ST STE W210
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City | SAINT PAUL
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State | MN
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Zip | 55114-1272
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Country | US
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Telephone | 612-424-0434
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Fax | 877-905-7069
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Provider Business Mailing Address
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Address Line | 104 SEYMOUR AVE SE
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City | MINNEAPOLIS
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State | MN
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Zip | 55414-3558
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Country | US
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Telephone | 612-424-0434
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Fax | 877-905-7069
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN BORDEN
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Credential | PMHNP
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Telephone | 612-424-0434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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