Healthcare Provider Details

I. General information

NPI: 1538627914
Provider Name (Legal Business Name): CHANDRA VIVIAN SORRELLE DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 N LITCHFIELD RD STE 102
GOODYEAR AZ
85395-7800
US

IV. Provider business mailing address

2910 N LITCHFIELD RD STE 102
GOODYEAR AZ
85395-7800
US

V. Phone/Fax

Practice location:
  • Phone: 480-584-4712
  • Fax: 833-973-6104
Mailing address:
  • Phone: 701-541-2144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRNP224090
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: