Provider Demographics
NPI:1073100822
Name:VERSIE, SONYA (RN)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:VERSIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4883 ARROWHEAD LN
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-6099
Mailing Address - Country:US
Mailing Address - Phone:901-619-9453
Mailing Address - Fax:888-503-3559
Practice Address - Street 1:4883 ARROWHEAD LN
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-6099
Practice Address - Country:US
Practice Address - Phone:901-619-9453
Practice Address - Fax:888-503-3559
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS896461163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS896461OtherSTATE BOARD OF NURSING