Healthcare Provider Details

I. General information

NPI: 1629224167
Provider Name (Legal Business Name): TRACY FIEGEN SORENSON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 W 22ND ST STE 101
SIOUX FALLS SD
57105-1514
US

IV. Provider business mailing address

1508 W 22ND ST STE 101
SIOUX FALLS SD
57105-1514
US

V. Phone/Fax

Practice location:
  • Phone: 605-328-3840
  • Fax: 605-328-3841
Mailing address:
  • Phone: 605-328-3840
  • Fax: 605-328-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP000535
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: