Healthcare Provider Details

I. General information

NPI: 1619361474
Provider Name (Legal Business Name): MATTHEW SORENSON PHD., ANP, ANP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4711 N RAVENSWOOD AVE
CHICAGO IL
60640-4407
US

IV. Provider business mailing address

990 WEST FULLERTON AVE STE 3000 DEPAUL UNIVERSITY/SCHOOL OF NURSING
CHICAGO IL
60614
US

V. Phone/Fax

Practice location:
  • Phone: 773-784-9000
  • Fax:
Mailing address:
  • Phone: 773-325-1887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209.011469
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: