Healthcare Provider Details

I. General information

NPI: 1013904754
Provider Name (Legal Business Name): JANETTE SUE SORENSEN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9411 WOODRIDGE CT
SAVAGE MN
55378-3151
US

IV. Provider business mailing address

9411 WOODRIDGE CT
SAVAGE MN
55378-3151
US

V. Phone/Fax

Practice location:
  • Phone: 952-233-7233
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR1590357
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: