Healthcare Provider Details

I. General information

NPI: 1780304162
Provider Name (Legal Business Name): SONJA LYNNE NORMAN AGAC-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SONJA LYNNE NOTESTINE

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 VAN BUREN ST
FORT WAYNE IN
46802-3697
US

IV. Provider business mailing address

16209 HAVENWOOD DR
WOODBURN IN
46797-9585
US

V. Phone/Fax

Practice location:
  • Phone: 260-425-3000
  • Fax:
Mailing address:
  • Phone: 260-437-7560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number28162270A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number71013287A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: