Provider Demographics
NPI:1184222028
Name:SORUM, JAMES WESLEY
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WESLEY
Last Name:SORUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5436 67TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:CHURCHS FERRY
Mailing Address - State:ND
Mailing Address - Zip Code:58325-9652
Mailing Address - Country:US
Mailing Address - Phone:701-580-7530
Mailing Address - Fax:
Practice Address - Street 1:5436 67TH AVE NE
Practice Address - Street 2:
Practice Address - City:CHURCHS FERRY
Practice Address - State:ND
Practice Address - Zip Code:58325-9652
Practice Address - Country:US
Practice Address - Phone:701-580-7530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant