Healthcare Provider Details

I. General information

NPI: 1497669139
Provider Name (Legal Business Name): NATHAN SORENSON FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10410 E GAMMA AVE
MESA AZ
85212-8775
US

IV. Provider business mailing address

10410 E GAMMA AVE
MESA AZ
85212-8775
US

V. Phone/Fax

Practice location:
  • Phone: 480-202-1828
  • Fax:
Mailing address:
  • Phone: 480-202-1828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number231457
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: