Provider Demographics
NPI:1194373639
Name:SOBIESZCZYK, OPAL ELAINE (RN)
Entity Type:Individual
Prefix:
First Name:OPAL
Middle Name:ELAINE
Last Name:SOBIESZCZYK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:OPAL
Other - Middle Name:ELAINE
Other - Last Name:SOBIESZCZYK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:42 ISLE OF HOPE
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-6634
Mailing Address - Country:US
Mailing Address - Phone:843-557-7829
Mailing Address - Fax:
Practice Address - Street 1:42 ISLE OF HOPE
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-6634
Practice Address - Country:US
Practice Address - Phone:843-557-7829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC217189163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool