Provider Demographics
NPI:1427651025
Name:SORUM, JANIS
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:
Last Name:SORUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:ELLENDALE
Mailing Address - State:ND
Mailing Address - Zip Code:58436-7218
Mailing Address - Country:US
Mailing Address - Phone:701-381-9404
Mailing Address - Fax:
Practice Address - Street 1:5436 67TH AVE NE
Practice Address - Street 2:
Practice Address - City:CHURCHS FERRY
Practice Address - State:ND
Practice Address - Zip Code:58325-9652
Practice Address - Country:US
Practice Address - Phone:701-570-2699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
385H00000X
ND14690863747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No385H00000XRespite Care FacilityRespite Care