Provider Demographics
NPI:1598542946
Name:GODINE, SOPHIA MARIE (MSN, APRN, CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:SOPHIA
Middle Name:MARIE
Last Name:GODINE
Suffix:
Gender:F
Credentials:MSN, APRN, CPNP-PC
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:MARIE
Other - Last Name:SCHUTTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2871 SAINT GEORGE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-5028
Mailing Address - Country:US
Mailing Address - Phone:913-952-2000
Mailing Address - Fax:
Practice Address - Street 1:101 W MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-6773
Practice Address - Country:US
Practice Address - Phone:336-249-4911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCGODI-RVYT7363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics