Individual
TEELA SORENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2038 W 1900 S, SYRACUSE, UT 84075-9320
(801) 773-4840
(801) 525-8151
Mailing address
PO BOX 337, LAYTON, UT 84041-0337
(801) 773-4840
(801) 525-8151
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
3713701205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005536827
MEDICARE #2
UT
01
—
005701332
MEDICARE #3
UT
05
—
D2779
—
UT
Enumeration date
12/21/2005
Last updated
07/23/2012
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