MEDICARE: DARREN L SORENSEN FNP

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	363LF0000X	Family Nurse Practitioner	8069304-4405	UT

General Provider Information

NPI Number	:	1932718590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARREN L SORENSEN FNP

Provider Business Mailing Address
First Line	:	4701 W 2100 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84120-1223
Country	:	US
Telephone Number	:	801-974-3382
Fax Number	:

Provider Business Practice Location Address
First Line	:	4701 W 2100 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84120-1223
Country	:	US
Telephone Number	:	801-974-3382
Fax Number	:

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

Provider Enumeration Date	:	07/29/2020
Last Update Date	:	05/13/2021

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