Provider Demographics
NPI:1255508479
Name:SORGE, LAURIE ANN (LAURIE SORGE NP)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:ANN
Last Name:SORGE
Suffix:
Gender:F
Credentials:LAURIE SORGE NP
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:SORGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAURIE SORGE NP
Mailing Address - Street 1:14 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-1510
Mailing Address - Country:US
Mailing Address - Phone:585-425-1153
Mailing Address - Fax:585-223-0018
Practice Address - Street 1:14 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-1510
Practice Address - Country:US
Practice Address - Phone:585-425-1153
Practice Address - Fax:585-223-0018
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340452363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology