Healthcare Provider Details

I. General information

NPI: 1306195821
Provider Name (Legal Business Name): MARGARET JANE SORG CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 LAFAYETTE RD SUITE 200
CRAWFORDSVILLE IN
47933-1098
US

IV. Provider business mailing address

1901 LAFAYETTE RD SUITE 200
CRAWFORDSVILLE IN
47933-1098
US

V. Phone/Fax

Practice location:
  • Phone: 765-361-3086
  • Fax:
Mailing address:
  • Phone: 765-361-3086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number71004109B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: