Provider Demographics
NPI:1508121203
Name:SZYMECZEK, SOPHIA ANGELA (RN, IBCLC)
Entity Type:Individual
Prefix:MS
First Name:SOPHIA
Middle Name:ANGELA
Last Name:SZYMECZEK
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 B GREENVILLE BLVD. SE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-2851
Mailing Address - Country:US
Mailing Address - Phone:252-364-8729
Mailing Address - Fax:
Practice Address - Street 1:2301 STANTONSBURG RD STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2851
Practice Address - Country:US
Practice Address - Phone:252-916-0933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NC73989163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies