Healthcare Provider Details

I. General information

NPI: 1962155382
Provider Name (Legal Business Name): ELIZABETH J SORENSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH J BANDE ARNP

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040A FITZSIMMONS ST
JOINT BASE LEWIS MCCHORD WA
98433-2010
US

IV. Provider business mailing address

2741 MEYER ST
DUPONT WA
98327-8710
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-3070
  • Fax:
Mailing address:
  • Phone: 253-227-7539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61595625
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: