MEDICARE: NICOLE KRISTINE SORGI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	4704288275	MI

General Provider Information

NPI Number	:	1386111938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE KRISTINE SORGI

Provider Business Mailing Address
First Line	:	148 STONETREE CIR
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-1138
Country	:	US
Telephone Number	:	248-701-0090
Fax Number	:

Provider Business Practice Location Address
First Line	:	148 STONETREE CIR
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-1138
Country	:	US
Telephone Number	:	248-701-0090
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2018
Last Update Date	:	12/11/2018

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Directions to “ NICOLE KRISTINE SORGI ” Practice Location

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