Provider Demographics
NPI:1003681941
Name:WILSON, SOPHIA ROCHELLE (BSN, RN)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ROCHELLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:ROCHELLE
Other - Last Name:GRAVLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:WAKE FOREST SCHOOL OF MEDICINE NURSE ANESTHESIA PROGRAM
Mailing Address - Street 2:525 VINE STREET
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-7065
Mailing Address - Country:US
Mailing Address - Phone:336-716-1411
Mailing Address - Fax:
Practice Address - Street 1:WAKE FOREST SCHOOL OF MEDICINE NURSE ANESTHESIA PROGRAM
Practice Address - Street 2:525 VINE STREET
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-7065
Practice Address - Country:US
Practice Address - Phone:336-716-1411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program