Provider Demographics
NPI:1497358972
Name:LANSANA, SOPHIE M
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:M
Last Name:LANSANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6845 MEADOW CREST DR APT 404
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-6674
Mailing Address - Country:US
Mailing Address - Phone:940-597-3073
Mailing Address - Fax:
Practice Address - Street 1:6845 MEADOW CREST DR APT 404
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-6674
Practice Address - Country:US
Practice Address - Phone:940-597-3073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX349837164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse