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General NPI Number Information
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NPI Number | 1467606350
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Entity Type | Individual
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Provider Name | CARRIE M SORENSEN PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/05/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1200 SIXTH ST STE 200
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-2369
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Country | US
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Telephone | 231-935-5800
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Fax | 231-935-5799
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Provider Business Mailing Address
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Address Line | 2891 MOMENTUM PL
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City | CHICAGO
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State | IL
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Zip | 60689-5328
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Country | US
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Telephone | 231-935-6080
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Fax | 231-935-6081
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA60051685
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License Number State | WA
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