Provider Demographics
NPI:1871643825
Name:SORENSON, MELISSA (GNP-BC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SORENSON
Suffix:
Gender:F
Credentials:GNP-BC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:KAY
Other - Last Name:BRACEWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3433 BROADWAY ST NE STE 300
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1761
Mailing Address - Country:US
Mailing Address - Phone:763-587-7737
Mailing Address - Fax:763-587-7069
Practice Address - Street 1:3433 BROADWAY ST NE STE 300
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1761
Practice Address - Country:US
Practice Address - Phone:763-587-7737
Practice Address - Fax:763-587-7069
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2581363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7344058-00Medicaid
MNQ41298Medicare UPIN
MN7344058-00Medicaid