Provider Demographics
NPI:1417416017
Name:LEFLORE, SONJA NICOLE (LPN)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:NICOLE
Last Name:LEFLORE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12335 MOLLY SUE LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-6630
Mailing Address - Country:US
Mailing Address - Phone:786-269-6962
Mailing Address - Fax:
Practice Address - Street 1:12335 MOLLY SUE LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-6630
Practice Address - Country:US
Practice Address - Phone:786-269-6962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN083366164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse