Provider Demographics
NPI:1942882279
Name:SOCLO, FEMINA MAMIE
Entity Type:Individual
Prefix:
First Name:FEMINA
Middle Name:MAMIE
Last Name:SOCLO
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 1:4111 LOCKPORT ST APT 200
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-5438
Mailing Address - Country:US
Mailing Address - Phone:701-319-2704
Mailing Address - Fax:
Practice Address - Street 1:4111 LOCKPORT ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-5596
Practice Address - Country:US
Practice Address - Phone:701-319-2704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3747P1801X3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant