MEDICARE: BOREALIS HEALTH PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363LF0000X	Family Nurse Practitioner
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184419228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOREALIS HEALTH PLLC

Provider Business Mailing Address
First Line	:	813 S POKEGAMA AVE STE B
Second Line	:
City	:	GRAND RAPIDS
State	:	MN
Zip	:	55744-3934
Country	:	US
Telephone Number	:	218-297-1900
Fax Number	:	218-203-4788

Provider Business Practice Location Address
First Line	:	813 S POKEGAMA AVE
Second Line	:	LOWER LEVEL
City	:	GRAND RAPIDS
State	:	MN
Zip	:	55744-3934
Country	:	US
Telephone Number	:	218-297-1900
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIE JON BATA
Credential	:
Telephone Number	:	218-297-1900

Provider Enumeration Date	:	04/10/2025
Last Update Date	:	01/28/2026

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Directions to “BOREALIS HEALTH PLLC ” Practice Location

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