Provider Demographics
NPI:1891441994
Name:SOPP, COLLEEN R (RN IBCLC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:R
Last Name:SOPP
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 1:1800 MISTY HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-6222
Mailing Address - Country:US
Mailing Address - Phone:919-219-2680
Mailing Address - Fax:
Practice Address - Street 1:1800 MISTY HOLLOW LN
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-6222
Practice Address - Country:US
Practice Address - Phone:919-219-2680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC206303163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant