Provider Demographics
NPI:1841620085
Name:SORENSEN, NATALIA ALEXANDROVNA (NP)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:ALEXANDROVNA
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NATALIA
Other - Middle Name:ALEXANDROVNA
Other - Last Name:EREMINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:2547 BUTTE ST
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-1841
Mailing Address - Country:US
Mailing Address - Phone:208-530-1087
Mailing Address - Fax:
Practice Address - Street 1:2547 BUTTE ST
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-1841
Practice Address - Country:US
Practice Address - Phone:208-530-1087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-26
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1378A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily