Provider Demographics
NPI:1083842751
Name:METTERS, SOPHIA LORENE
Entity Type:Individual
Prefix:MRS
First Name:SOPHIA
Middle Name:LORENE
Last Name:METTERS
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 1:8024 DUBEN AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1540
Mailing Address - Country:US
Mailing Address - Phone:907-720-9540
Mailing Address - Fax:907-644-0511
Practice Address - Street 1:2735 E TUDOR RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1135
Practice Address - Country:US
Practice Address - Phone:907-562-7900
Practice Address - Fax:907-562-7901
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK171M00000X171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator