Provider Demographics
NPI:1285154187
Name:SORENSEN, JENNA KATHLEEN (LAT, ATC)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:KATHLEEN
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:KATHLEEN
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:3328 E DERRINGER WAY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-7776
Mailing Address - Country:US
Mailing Address - Phone:623-236-6485
Mailing Address - Fax:
Practice Address - Street 1:350 N ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-4578
Practice Address - Country:US
Practice Address - Phone:480-812-7702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ257040163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Single Specialty