Provider Demographics
NPI:1700115144
Name:SORENSON, ARCHIMEDES SAHAGUN-FERNANDO (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:ARCHIMEDES
Middle Name:SAHAGUN-FERNANDO
Last Name:SORENSON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:ARCHIMEDES
Other - Middle Name:SAHAGUN
Other - Last Name:FERNANDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CMR 402
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CMR 402
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180
Practice Address - Country:US
Practice Address - Phone:49637-186-8590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR 89176363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics