Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 18040 | NV |
N | 207SG0201X | Clinical Genetics (M.D.) | 244966 | NY |
NPI | 1770741555 |
---|---|
Provider Name | Dr. Susanna Sorrentino |
First Address | Henderson, NV 89052-5551 |
Second Address | Henderson, NV 89052-5551 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2008 |
Last Update Date | 14/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1770741555 | (05) | NV |