Provider Demographics
NPI:1295130540
Name:ABBOTT, SOPHIA (RN)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 GLENLEIGH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-3518
Mailing Address - Country:US
Mailing Address - Phone:434-566-9407
Mailing Address - Fax:
Practice Address - Street 1:618 FOREST ST STE B
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-5267
Practice Address - Country:US
Practice Address - Phone:434-566-9407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2288764163WP2201X
VA1236000890174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care