Provider Demographics
NPI:1396841102
Name:SONNENTAG, NORMA J (PA)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:J
Last Name:SONNENTAG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1150 W 24TH ST
Mailing Address - Street 2:STE F
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8368
Mailing Address - Country:US
Mailing Address - Phone:928-782-3819
Mailing Address - Fax:928-783-6623
Practice Address - Street 1:1150 W 24TH ST
Practice Address - Street 2:STE F
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8368
Practice Address - Country:US
Practice Address - Phone:928-782-3819
Practice Address - Fax:928-783-6623
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2008-03-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ2178363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ117141Medicare PIN