Provider Demographics
NPI:1134760903
Name:SORTEBERG, NICHOLE KATHLEEN (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:KATHLEEN
Last Name:SORTEBERG
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 MINNESOTA DR. STE 100
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435
Mailing Address - Country:US
Mailing Address - Phone:952-920-6545
Mailing Address - Fax:952-920-6611
Practice Address - Street 1:3601 MINNESOTA DR. STE 100
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-920-6545
Practice Address - Fax:952-920-6611
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6973363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner