Provider Demographics
NPI:1306195821
Name:SORG, MARGARET JANE (CPNP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:JANE
Last Name:SORG
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 LAFAYETTE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-1098
Mailing Address - Country:US
Mailing Address - Phone:765-361-3086
Mailing Address - Fax:
Practice Address - Street 1:1901 LAFAYETTE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-1098
Practice Address - Country:US
Practice Address - Phone:765-361-3086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004109B363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201098420Medicaid