Provider Demographics
NPI:1457052623
Name:SORENSON, MELISSA LYNN
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:SORENSON
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 1:920B DAVIS MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:PEEBLES
Mailing Address - State:OH
Mailing Address - Zip Code:45660-9509
Mailing Address - Country:US
Mailing Address - Phone:937-779-7516
Mailing Address - Fax:
Practice Address - Street 1:920B DAVIS MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:PEEBLES
Practice Address - State:OH
Practice Address - Zip Code:45660-9509
Practice Address - Country:US
Practice Address - Phone:937-779-7516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide