Provider Demographics
NPI:1265659940
Name:SORENSEN, LISA K (ANP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:K
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1645 GLEN MOOR DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-3033
Mailing Address - Country:US
Mailing Address - Phone:720-350-6257
Mailing Address - Fax:
Practice Address - Street 1:10101 RIDGEGATE PKWY
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5522
Practice Address - Country:US
Practice Address - Phone:720-225-1981
Practice Address - Fax:720-225-1889
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO95813363LA2200X
COAPN.0001749-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP61094Medicare UPIN