Provider Demographics
NPI:1366110819
Name:SOREM, ARISALEE JUNE (LC)
Entity type:Individual
Prefix:
First Name:ARISALEE
Middle Name:JUNE
Last Name:SOREM
Suffix:
Gender:F
Credentials:LC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 RIVER OAKS LN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:TX
Mailing Address - Zip Code:75103-1140
Mailing Address - Country:US
Mailing Address - Phone:209-217-6897
Mailing Address - Fax:
Practice Address - Street 1:342 RIVER OAKS LN
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-1140
Practice Address - Country:US
Practice Address - Phone:209-217-6897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN