Provider Demographics
NPI:1780304162
Name:NORMAN, SONJA LYNNE (AGAC-NP)
Entity type:Individual
Prefix:
First Name:SONJA
Middle Name:LYNNE
Last Name:NORMAN
Suffix:
Gender:F
Credentials:AGAC-NP
Other - Prefix:
Other - First Name:SONJA
Other - Middle Name:LYNNE
Other - Last Name:NOTESTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16209 HAVENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46797-9585
Mailing Address - Country:US
Mailing Address - Phone:260-437-7560
Mailing Address - Fax:
Practice Address - Street 1:702 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-3697
Practice Address - Country:US
Practice Address - Phone:260-425-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28162270A163WC0200X
IN71013287A363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine