Healthcare Provider Details

I. General information

NPI: 1952496226
Provider Name (Legal Business Name): CATHY ANN SOREM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 VETERANS DRIVE A116-R BLDG. 61A, ROOM 123
TACOMA WA
98493
US

IV. Provider business mailing address

12705 114TH ST. CT. EAST
PUYALLUP WA
98374
US

V. Phone/Fax

Practice location:
  • Phone: 253-583-1671
  • Fax: 253-589-4106
Mailing address:
  • Phone: 253-583-1671
  • Fax: 253-589-4106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN00122345
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: