Individual
MRS. MICHELLE BORZIK GORETH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-AC
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5050
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5050
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
R860018
MS
363LA2100X
Acute Care Nurse Practitioner
Primary
R860018
MS
363LP0222X
Critical Care Pediatric Nurse Practitioner
794000
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02855367
—
MS
05
—
179192
—
AL
Enumeration date
06/09/2010
Last updated
12/10/2015
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