Provider Demographics
NPI:1235450438
Name:SORRELL, ROD (CNA)
Entity Type:Individual
Prefix:
First Name:ROD
Middle Name:
Last Name:SORRELL
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 EAST NINTH AVENUE
Mailing Address - Street 2:SIERRA VISTA HOSPITAL
Mailing Address - City:TRUTH OR CONSEQUENCES
Mailing Address - State:NM
Mailing Address - Zip Code:87901
Mailing Address - Country:US
Mailing Address - Phone:575-894-2111
Mailing Address - Fax:575-894-7659
Practice Address - Street 1:800 EAST NINTH AVENUE
Practice Address - Street 2:SIERRA VISTA HOSPITAL
Practice Address - City:TRUTH OR CONSEQUENCES
Practice Address - State:NM
Practice Address - Zip Code:87901
Practice Address - Country:US
Practice Address - Phone:575-894-2111
Practice Address - Fax:575-894-7659
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide