Provider Demographics
NPI:1962155382
Name:SORENSON, ELIZABETH J (ARNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:SORENSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:J
Other - Last Name:BANDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:2741 MEYER ST
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-8710
Mailing Address - Country:US
Mailing Address - Phone:253-227-7539
Mailing Address - Fax:
Practice Address - Street 1:9040A FITZSIMMONS ST
Practice Address - Street 2:
Practice Address - City:JOINT BASE LEWIS MCCHORD
Practice Address - State:WA
Practice Address - Zip Code:98433-2010
Practice Address - Country:US
Practice Address - Phone:253-968-3070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61595625363LP0808X
WARN00116275163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty