1982831202 NPI number — AUSTIN L SORENSEN MSW

Table of content: AUSTIN L SORENSEN MSW (NPI 1982831202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982831202 NPI number — AUSTIN L SORENSEN MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SORENSEN
Provider First Name:
AUSTIN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982831202
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1020 AVENUE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELY
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89301-2407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-293-1558
Provider Business Mailing Address Fax Number:
775-375-0813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
802 AVENUE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELY
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89301-2423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-293-1558
Provider Business Practice Location Address Fax Number:
775-375-0813
Provider Enumeration Date:
06/12/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  6171-C , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 104100000X , with the licence number: PENDING , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)