Provider Demographics
NPI:1558362038
Name:BOROWIECKI, HEIDI K (NP)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:K
Last Name:BOROWIECKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:KEVORKIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4530 W JUPITER WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-4843
Mailing Address - Country:US
Mailing Address - Phone:480-899-5530
Mailing Address - Fax:480-899-4295
Practice Address - Street 1:1701 38TH ST S STE 101
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4499
Practice Address - Country:US
Practice Address - Phone:701-356-1500
Practice Address - Fax:701-356-1596
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10330363L00000X
NDR52342363L00000X
MN2515356163W00000X
AZ0286276-22363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCMK0434958OtherDEA