Basic Information
| Provider Information | |||||||||
| NPI: | 1841713641 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SORBO | ||||||||
| FirstName: | TESS | ||||||||
| MiddleName: | DOMINIQUE | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4238 EVANSTON AVE N APT 8 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981037239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057128463 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1050 140TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253733000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2017 | ||||||||
| LastUpdateDate: | 10/09/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP60793949 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 163W00000X | RN60669700 | WA | N | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 1929007 | 01 | WA | MERCER PROLIABILITY | OTHER |