Provider Demographics
NPI:1366128019
Name:SORENSEN, MAKYELA DAWN (PA-C)
Entity type:Individual
Prefix:MISS
First Name:MAKYELA
Middle Name:DAWN
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GREYBULL
Mailing Address - State:WY
Mailing Address - Zip Code:82426-2133
Mailing Address - Country:US
Mailing Address - Phone:307-209-3391
Mailing Address - Fax:307-207-0392
Practice Address - Street 1:6 S 5TH ST
Practice Address - Street 2:
Practice Address - City:GREYBULL
Practice Address - State:WY
Practice Address - Zip Code:82426-2133
Practice Address - Country:US
Practice Address - Phone:307-209-3391
Practice Address - Fax:307-207-0392
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant