Individual
KISA SUE SORG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
S10904 FAIRVIEW RD, SPRING GREEN, WI 53588-9738
(608) 415-1524
Mailing address
S10904 FAIRVIEW RD, SPRING GREEN, WI 53588-9738
(608) 415-1524
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
1121107-30
WI
164W00000X
Licensed Practical Nurse
332331-31
WI
Other
Enumeration date
12/02/2024
Last updated
06/23/2025
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