Healthcare Provider Details

I. General information

NPI: 1568421261
Provider Name (Legal Business Name): TERRI ANN SORG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9456 HOWERY RD
MOUNT HOREB WI
53572-1124
US

IV. Provider business mailing address

N2351 COUNTY RD N
LYNDON STATION WI
53944-9715
US

V. Phone/Fax

Practice location:
  • Phone: 608-798-2337
  • Fax:
Mailing address:
  • Phone: 608-666-4313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number72786030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: