Provider Demographics
NPI:1366680761
Name:SORENSEN, VICKIE D (LDEM CPM)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:D
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:LDEM CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W ROYAL HUNTE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-1800
Mailing Address - Country:US
Mailing Address - Phone:435-586-4854
Mailing Address - Fax:435-865-1629
Practice Address - Street 1:1800 W ROYAL HUNTE DR
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-1800
Practice Address - Country:US
Practice Address - Phone:435-586-4854
Practice Address - Fax:435-865-1629
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QB0400X, 174N00000X
UT8858598-3400176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
No174N00000XOther Service ProvidersLactation Consultant, Non-RN