MEDICARE: GINA JOAN GILMOUR SORSEN

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	183700000X	Pharmacy Technician	729171	MN

General Provider Information

NPI Number	:	1447640982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA JOAN GILMOUR SORSEN

Provider Business Mailing Address
First Line	:	2001 EDGEWOOD CT SW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55902-2274
Country	:	US
Telephone Number	:	608-738-1015
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 EDGEWOOD CT SW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55902-2274
Country	:	US
Telephone Number	:	608-738-1015
Fax Number	:

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

Provider Enumeration Date	:	02/04/2015
Last Update Date	:	02/04/2015

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