Provider Demographics
NPI:1073112827
Name:SORENSON, MIRANDA KAY
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:KAY
Last Name:SORENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12302 313TH AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-3320
Mailing Address - Country:US
Mailing Address - Phone:320-535-0797
Mailing Address - Fax:
Practice Address - Street 1:12302 313TH AVE
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-3320
Practice Address - Country:US
Practice Address - Phone:320-535-0797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula