Healthcare Provider Details

I. General information

NPI: 1396724316
Provider Name (Legal Business Name): ARNE LEROY SORENSON RD, LN, CDE
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MINNI TOHE DR
NEW TOWN ND
58763-4400
US

IV. Provider business mailing address

PO BOX 400 1 MINNE TOHE DRIVE
NEW TOWN ND
58763-0400
US

V. Phone/Fax

Practice location:
  • Phone: 701-627-4701
  • Fax: 701-627-3913
Mailing address:
  • Phone: 701-627-4701
  • Fax: 701-627-3913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number0122
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: