Healthcare Provider Details

I. General information

NPI: 1376470872
Provider Name (Legal Business Name): SOPHIA MACLEAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10978 DONNER PASS RD FL 2
TRUCKEE CA
96161-0433
US

IV. Provider business mailing address

12973 HILLSIDE DR
TRUCKEE CA
96161-6332
US

V. Phone/Fax

Practice location:
  • Phone: 530-550-6716
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95305443
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: