Provider Demographics
NPI:1225303183
Name:SORENSEN, REBEKAH (PA)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:908 NIAGARA FALLS BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2019
Mailing Address - Country:US
Mailing Address - Phone:716-692-3302
Mailing Address - Fax:833-953-2016
Practice Address - Street 1:515 MAIN ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1513
Practice Address - Country:US
Practice Address - Phone:716-701-1510
Practice Address - Fax:716-701-1517
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2020-04-21
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant