Provider Demographics
NPI:1427445766
Name:BORGMAN, KELLI ANN (RD)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:ANN
Last Name:BORGMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 CREST RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-9503
Mailing Address - Country:US
Mailing Address - Phone:802-524-8824
Mailing Address - Fax:802-524-8498
Practice Address - Street 1:260 CREST RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-9503
Practice Address - Country:US
Practice Address - Phone:802-524-8824
Practice Address - Fax:802-524-8498
Is Sole Proprietor?:No
Enumeration Date:2015-04-24
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT074.0120144133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered