Provider Demographics
NPI:1154794303
Name:SORRELL, SUZANNE (RN)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:SORRELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9208 TUDOR PARK PL
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-8726
Mailing Address - Country:US
Mailing Address - Phone:702-612-4945
Mailing Address - Fax:
Practice Address - Street 1:9208 TUDOR PARK PL
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-8726
Practice Address - Country:US
Practice Address - Phone:702-612-4945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV61767163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse