Provider Demographics
NPI:1457816597
Name:SONENSCHEIN, MARK GREGORY (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:GREGORY
Last Name:SONENSCHEIN
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 N SCOTTSDALE RD STE 400
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-3634
Mailing Address - Country:US
Mailing Address - Phone:844-646-3247
Mailing Address - Fax:
Practice Address - Street 1:1465 N SCOTTSDALE RD STE 400
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-3634
Practice Address - Country:US
Practice Address - Phone:844-646-3247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-03
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ221933363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health