Provider Demographics
NPI:1689948176
Name:SORENSEN, ALLYSON EGGERTZ (PA-C)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:EGGERTZ
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 WEST 4700 SOUTH
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84129-3457
Mailing Address - Country:US
Mailing Address - Phone:801-213-9200
Mailing Address - Fax:
Practice Address - Street 1:3730 WEST 4700 SOUTH
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84129-3457
Practice Address - Country:US
Practice Address - Phone:801-213-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03314363A00000X
UT8350084-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant