Healthcare Provider Details

I. General information

NPI: 1396747044
Provider Name (Legal Business Name): BETHANIE B. SORENSEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETHANIE BOBBI PAUL PA-C

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10815 W MCDOWELL RD STE 202
AVONDALE AZ
85392-5010
US

IV. Provider business mailing address

3815 E BELL RD STE 4500
PHOENIX AZ
85032-2171
US

V. Phone/Fax

Practice location:
  • Phone: 623-433-0202
  • Fax: 623-433-0204
Mailing address:
  • Phone: 602-633-3838
  • Fax: 602-633-3845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2906
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: