Healthcare Provider Details

I. General information

NPI: 1013729318
Provider Name (Legal Business Name): GREGORY SORENSEN APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3065 E HOLLY DR
ST GEORGE UT
84790-1321
US

IV. Provider business mailing address

3065 E HOLLY DR
ST GEORGE UT
84790-1321
US

V. Phone/Fax

Practice location:
  • Phone: 603-986-3397
  • Fax:
Mailing address:
  • Phone: 603-986-3397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10168835-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: