Provider Demographics
NPI:1265821664
Name:SOPPE, ELENA RAE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:ELENA
Middle Name:RAE
Last Name:SOPPE
Suffix:
Gender:F
Credentials:CNP
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Mailing Address - Street 1:2912 SPRINGBORO RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1674
Mailing Address - Country:US
Mailing Address - Phone:937-277-1722
Mailing Address - Fax:937-277-8618
Practice Address - Street 1:77 E WOODBURY DR
Practice Address - Street 2:SUITE 110
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2855
Practice Address - Country:US
Practice Address - Phone:937-277-1722
Practice Address - Fax:937-277-8618
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2015-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH17013363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0117745Medicaid