Provider Demographics
NPI:1750032199
Name:SORENSEN, MELISSA ANN (LPN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 DOUGHERTY CT
Mailing Address - Street 2:
Mailing Address - City:RIDGEWAY
Mailing Address - State:WI
Mailing Address - Zip Code:53582-9722
Mailing Address - Country:US
Mailing Address - Phone:608-341-6331
Mailing Address - Fax:
Practice Address - Street 1:114 DOUGHERTY CT
Practice Address - Street 2:
Practice Address - City:RIDGEWAY
Practice Address - State:WI
Practice Address - Zip Code:53582-9722
Practice Address - Country:US
Practice Address - Phone:608-341-6331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30207631164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse