Provider Demographics
NPI:1710793773
Name:SORRELLS, AMY K
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:K
Last Name:SORRELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4365 WEATHER STONE XING
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-8576
Mailing Address - Country:US
Mailing Address - Phone:317-201-2689
Mailing Address - Fax:
Practice Address - Street 1:4365 WEATHER STONE XING
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-8576
Practice Address - Country:US
Practice Address - Phone:317-201-2689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28126017A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse