Provider Demographics
NPI:1568480713
Name:SORENSEN, MARILYN (FNP)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:
Other - Last Name:HALVORSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:97 PROFESSIONAL WAY
Practice Address - Street 2:SUITE 2
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-1614
Practice Address - Country:US
Practice Address - Phone:801-465-4869
Practice Address - Fax:801-465-4107
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT198782-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner