Provider Demographics
NPI:1649571480
Name:SORENSON, BEVERLY (L AC)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:SORENSON
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2448 W MARSTON DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-1116
Mailing Address - Country:US
Mailing Address - Phone:907-222-3450
Mailing Address - Fax:907-222-5983
Practice Address - Street 1:626 CORDOVA ST STE 103
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3783
Practice Address - Country:US
Practice Address - Phone:907-222-3450
Practice Address - Fax:907-222-5983
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK66171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist