Provider Demographics
NPI:1558769323
Name:BLUNT, SOPHIA
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:BLUNT
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 1:8859 BRISTOL PARK DR
Mailing Address - Street 2:APT 205
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4174
Mailing Address - Country:US
Mailing Address - Phone:901-270-4102
Mailing Address - Fax:
Practice Address - Street 1:8859 BRISTOL PARK DR
Practice Address - Street 2:APT 205
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4174
Practice Address - Country:US
Practice Address - Phone:901-270-4102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN194480163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse