Provider Demographics
NPI:1144674821
Name:NORBU, SONAM (MS, RN, AG-ACNP)
Entity type:Individual
Prefix:MRS
First Name:SONAM
Middle Name:
Last Name:NORBU
Suffix:
Gender:F
Credentials:MS, RN, AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4887 WHEATSTONE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-2341
Mailing Address - Country:US
Mailing Address - Phone:937-474-3570
Mailing Address - Fax:
Practice Address - Street 1:4887 WHEATSTONE DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-2341
Practice Address - Country:US
Practice Address - Phone:937-474-3570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174624363LA2100X
MDR227564363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1144674821Medicaid