Provider Demographics
NPI:1710433792
Name:SONDERVAN, CORI ELIZABETH (APN, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:CORI
Middle Name:ELIZABETH
Last Name:SONDERVAN
Suffix:
Gender:F
Credentials:APN, FNP-C
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Mailing Address - Street 1:4290 MISTY HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:RAVENEL
Mailing Address - State:SC
Mailing Address - Zip Code:29470-3325
Mailing Address - Country:US
Mailing Address - Phone:201-749-6061
Mailing Address - Fax:
Practice Address - Street 1:1671 BELLE ISLE AVE STE 110J
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8336
Practice Address - Country:US
Practice Address - Phone:844-994-6633
Practice Address - Fax:470-300-7913
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00665200363LF0000X
SC28000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily