Provider Demographics
NPI:1548480627
Name:BORSTAD, ANN LOUISE (RN)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:LOUISE
Last Name:BORSTAD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:ANN
Other - Middle Name:LOUISE
Other - Last Name:HANTHO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 383
Mailing Address - Street 2:2812 210TH ST
Mailing Address - City:DAWSON
Mailing Address - State:MN
Mailing Address - Zip Code:56232
Mailing Address - Country:US
Mailing Address - Phone:320-769-2706
Mailing Address - Fax:320-769-2706
Practice Address - Street 1:106 NORTH 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1034
Practice Address - Country:US
Practice Address - Phone:218-998-3778
Practice Address - Fax:218-998-3187
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0765206163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse