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NPI Code Detail

MEDICARE: MRS. TRACY FIEGEN SORENSON CNP

MEDICARE: MRS. TRACY FIEGEN SORENSON CNP
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
1363LF0000XFamily Nurse PractitionerCP000535SD

General Provider Information

NPI Number : 1629224167
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TRACY FIEGEN SORENSON CNP
Provider Business Mailing Address
First Line : 1508 W 22ND ST STE 101
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57105-1514
Country : US
Telephone Number : 605-328-3840
Fax Number : 605-328-3841
Provider Business Practice Location Address
First Line : 1508 W 22ND ST STE 101
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57105-1514
Country : US
Telephone Number : 605-328-3840
Fax Number : 605-328-3841
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2008
Last Update Date : 09/09/2008

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