Healthcare Provider Details

I. General information

NPI: 1205146362
Provider Name (Legal Business Name): SORELLE NICOLE JONES COOPER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 HUNT PL NE
WASHINGTON DC
20019-3565
US

IV. Provider business mailing address

4130 HUNT PL NE
WASHINGTON DC
20019-3565
US

V. Phone/Fax

Practice location:
  • Phone: 202-388-8160
  • Fax: 202-388-8746
Mailing address:
  • Phone: 202-388-8160
  • Fax: 202-388-8746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR183786
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: