Provider Demographics
NPI:1699381673
Name:SORENSEN, SUSANA TREMOCHA
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:TREMOCHA
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 SILVER LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-2443
Mailing Address - Country:US
Mailing Address - Phone:419-529-9463
Mailing Address - Fax:
Practice Address - Street 1:1426 SILVER LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-2443
Practice Address - Country:US
Practice Address - Phone:419-529-9463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker