Provider Demographics
NPI:1396747044
Name:SORENSEN, BETHANIE B (PA-C)
Entity type:Individual
Prefix:
First Name:BETHANIE
Middle Name:B
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BETHANIE
Other - Middle Name:BOBBI
Other - Last Name:PAUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3815 E BELL RD STE 4500
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2171
Mailing Address - Country:US
Mailing Address - Phone:602-633-3838
Mailing Address - Fax:602-633-3845
Practice Address - Street 1:10815 W MCDOWELL RD STE 202
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-5010
Practice Address - Country:US
Practice Address - Phone:623-433-0202
Practice Address - Fax:623-433-0204
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2906363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ832693Medicaid
Z145996OtherMEDICARE
Q07371Medicare UPIN
Z141838Medicare PIN