Provider Demographics
NPI:1891310249
Name:SOUM, BOPHAR MARIE-FRANCE (LPN)
Entity Type:Individual
Prefix:
First Name:BOPHAR
Middle Name:MARIE-FRANCE
Last Name:SOUM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 SOUTH RD STE 44-216
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-7003
Mailing Address - Country:US
Mailing Address - Phone:845-797-7585
Mailing Address - Fax:
Practice Address - Street 1:2143 SAWKILL RUBY RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-7127
Practice Address - Country:US
Practice Address - Phone:845-797-7585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY313887164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse