Individual
GWEN R SORENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1086 LOWELL VLY, DAGMAR, MT 59219-9719
(763) 360-2515
Mailing address
1086 LOWELL VLY, DAGMAR, MT 59219-9719
(763) 360-2515
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000272867
MONTANA HEALTHCAR PROGRAM PROVIDE NUMBER
MT
Enumeration date
03/24/2010
Last updated
03/24/2010
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