Healthcare Provider Details

I. General information

NPI: 1427913011
Provider Name (Legal Business Name): JONI RAE SORRELS CCHW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 JEFFERSON ST NE
ALBUQUERQUE NM
87109-2155
US

IV. Provider business mailing address

5800 OSUNA RD NE APT 237
ALBUQUERQUE NM
87109-7236
US

V. Phone/Fax

Practice location:
  • Phone: 406-200-3001
  • Fax:
Mailing address:
  • Phone: 406-200-3001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberG-1937
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: