Provider Demographics
NPI:1851593826
Name:SONNTAG, NORMA F (RN)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:F
Last Name:SONNTAG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7495 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-2013
Mailing Address - Country:US
Mailing Address - Phone:801-213-9618
Mailing Address - Fax:801-213-9620
Practice Address - Street 1:7495 S STATE ST
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-2013
Practice Address - Country:US
Practice Address - Phone:801-213-9618
Practice Address - Fax:801-213-9620
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2224443102163WC0400X
UT1306883954183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WC0400XNursing Service ProvidersRegistered NurseCase Management
Not Answered183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT876000525450Medicaid