Provider Demographics
NPI:1386111938
Name:SORGI, NICOLE KRISTINE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:KRISTINE
Last Name:SORGI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:KRISTINE
Other - Last Name:DEMARTINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:148 STONETREE CIR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1138
Mailing Address - Country:US
Mailing Address - Phone:248-701-0090
Mailing Address - Fax:
Practice Address - Street 1:148 STONETREE CIR
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1138
Practice Address - Country:US
Practice Address - Phone:248-701-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704288275367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered