Provider Demographics
NPI:1619287810
Name:SORENSON, KRISTI L (RN)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:L
Last Name:SORENSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2853 AAKER RD
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-4145
Mailing Address - Country:US
Mailing Address - Phone:608-205-7512
Mailing Address - Fax:
Practice Address - Street 1:2853 AAKER RD
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-4145
Practice Address - Country:US
Practice Address - Phone:608-205-7512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132095-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI132095-30OtherRN