Provider Demographics
NPI:1497344329
Name:JETER-ADAMS, SOPHIA R (RN)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:R
Last Name:JETER-ADAMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:R
Other - Last Name:JETER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:166 ROBINWOOD AVE APT OR
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-6530
Mailing Address - Country:US
Mailing Address - Phone:516-483-4269
Mailing Address - Fax:516-483-4269
Practice Address - Street 1:166 ROBINWOOD AVE
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-6530
Practice Address - Country:US
Practice Address - Phone:516-483-4269
Practice Address - Fax:516-483-4269
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY554390163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health