Provider Demographics
NPI:1225718141
Name:SOPKO, OLIVIA GRACE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:OLIVIA
Middle Name:GRACE
Last Name:SOPKO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 GREENBRIAR RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-1335
Mailing Address - Country:US
Mailing Address - Phone:717-849-5465
Mailing Address - Fax:717-767-6716
Practice Address - Street 1:520 GREENBRIAR RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-1335
Practice Address - Country:US
Practice Address - Phone:717-849-5465
Practice Address - Fax:717-767-6716
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA064891363AM0700X
PAOA006621363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical