Provider Demographics
NPI:1619565322
Name:SORENSEN, SARA LYNN (RN, CNP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LYNN
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6435 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55346-1215
Mailing Address - Country:US
Mailing Address - Phone:605-988-4010
Mailing Address - Fax:
Practice Address - Street 1:4420 VALLEY VIEW RD
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1870
Practice Address - Country:US
Practice Address - Phone:952-456-2310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7949363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health