Provider Demographics
NPI:1508826694
Name:SORENSEN, ELAINE MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARIE
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W7642 COUNTY ROAD J
Mailing Address - Street 2:P. O. BOX 12
Mailing Address - City:BELDENVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54003-4706
Mailing Address - Country:US
Mailing Address - Phone:715-273-3569
Mailing Address - Fax:
Practice Address - Street 1:1300 MAPLE ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-9395
Practice Address - Country:US
Practice Address - Phone:715-684-4655
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28781- 031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39946400Medicaid