Provider Demographics
NPI:1295779601
Name:SORENSEN, SUSAN J (RD, CDE)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:J
Last Name:SORENSEN
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Gender:F
Credentials:RD, CDE
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Mailing Address - Street 1:6465 WAYZATA BLVD
Mailing Address - Street 2:STE 315
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1728
Mailing Address - Country:US
Mailing Address - Phone:952-993-7169
Mailing Address - Fax:952-993-0300
Practice Address - Street 1:3800 PARK NICOLLET BLVD
Practice Address - Street 2:INTERNATIONAL DIABETES CENTER
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2527
Practice Address - Country:US
Practice Address - Phone:952-993-3393
Practice Address - Fax:952-993-1302
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MNR 116470-9163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator