Provider Demographics
NPI:1518266915
Name:SORG, AMY (CRNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SORG
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:COUDERSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16915-8161
Mailing Address - Country:US
Mailing Address - Phone:814-225-4241
Mailing Address - Fax:814-225-4681
Practice Address - Street 1:139 MAIN ST
Practice Address - Street 2:
Practice Address - City:ELDRED
Practice Address - State:PA
Practice Address - Zip Code:16731-4515
Practice Address - Country:US
Practice Address - Phone:814-225-4241
Practice Address - Fax:814-225-4681
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011291363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily