Provider Demographics
NPI:1861094120
Name:SORENSON, ALICIA MARIE (AGACNP)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:MARIE
Last Name:SORENSON
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2812 N VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-4267
Mailing Address - Country:US
Mailing Address - Phone:989-721-1095
Mailing Address - Fax:
Practice Address - Street 1:2812 N VERMONT AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-4267
Practice Address - Country:US
Practice Address - Phone:989-721-1095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2019059469363LA2100X
MI4704295472363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care