Provider Demographics
NPI:1134724834
Name:SORENSON, AMANDA LEIGH
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEIGH
Last Name:SORENSON
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:PO BOX 377331
Mailing Address - Street 2:
Mailing Address - City:OCEAN VIEW
Mailing Address - State:HI
Mailing Address - Zip Code:96737-7331
Mailing Address - Country:US
Mailing Address - Phone:808-990-1611
Mailing Address - Fax:
Practice Address - Street 1:92-1628 LUAU DR.
Practice Address - Street 2:
Practice Address - City:OCEANVIEW
Practice Address - State:HI
Practice Address - Zip Code:96737-9673
Practice Address - Country:US
Practice Address - Phone:808-990-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty