Provider Demographics
NPI:1063918241
Name:MALMBORG, JENNIFER LEE (RN-BSN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:MALMBORG
Suffix:
Gender:F
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BOLDUC AVE
Mailing Address - Street 2:
Mailing Address - City:FORT KENT
Mailing Address - State:ME
Mailing Address - Zip Code:04743-1602
Mailing Address - Country:US
Mailing Address - Phone:207-834-3971
Mailing Address - Fax:207-834-3837
Practice Address - Street 1:12 BOLDUC AVE
Practice Address - Street 2:
Practice Address - City:FORT KENT
Practice Address - State:ME
Practice Address - Zip Code:04743-1602
Practice Address - Country:US
Practice Address - Phone:207-834-3971
Practice Address - Fax:207-834-3837
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN54077163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management