Provider Demographics
NPI:1881901718
Name:SONNEBORN, KATHERIN ADRIANA (PA)
Entity type:Individual
Prefix:
First Name:KATHERIN
Middle Name:ADRIANA
Last Name:SONNEBORN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HOLLAND WAY FL 1
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2997
Mailing Address - Country:US
Mailing Address - Phone:603-775-7405
Mailing Address - Fax:603-775-7424
Practice Address - Street 1:3 ALUMNI DR STE 301
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2123
Practice Address - Country:US
Practice Address - Phone:603-775-7405
Practice Address - Fax:603-775-7424
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1029363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3097987Medicaid
NH3097987Medicaid