Healthcare Provider Details

I. General information

NPI: 1235200551
Provider Name (Legal Business Name): JOSEPH GERARD SORENSEN NNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

118 BRIERWOOD LN
BURLINGTON VT
05401-2604
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-2370
  • Fax:
Mailing address:
  • Phone: 802-847-2370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number101-0017277
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: