Provider Demographics
NPI:1912949926
Name:SORENSEN, MEGAN JAYE (DNP, CNS)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:JAYE
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:DNP, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 NW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3857
Mailing Address - Country:US
Mailing Address - Phone:503-269-3610
Mailing Address - Fax:541-735-9463
Practice Address - Street 1:2727 NW 9TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3857
Practice Address - Country:US
Practice Address - Phone:503-269-3610
Practice Address - Fax:541-735-9463
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201604311CNS-PP363L00000X, 364SP0808X
MNR172938-0364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN622655800Medicaid
P86631Medicare UPIN