Provider Demographics
NPI:1396909826
Name:BORINO, NOREEN ELLEN (NP)
Entity type:Individual
Prefix:MRS
First Name:NOREEN
Middle Name:ELLEN
Last Name:BORINO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:NOREEN
Other - Last Name:WALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1490 E FOREMASTER DR STE 360
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4508
Mailing Address - Country:US
Mailing Address - Phone:435-359-3115
Mailing Address - Fax:435-291-1096
Practice Address - Street 1:1490 E FOREMASTER DR STE 360
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4508
Practice Address - Country:US
Practice Address - Phone:435-359-3115
Practice Address - Fax:435-291-1096
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN00223207Q00000X
NVAPN223363LX0001X
UT11644569-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1396909826Medicaid
NVAPRN00223OtherSTATE LICENSE
APRN00223OtherOTHER