Healthcare Provider Details

I. General information

NPI: 1134032030
Provider Name (Legal Business Name): SOPHIE ROSE OSCAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W FAIR AVE STE 285
MARQUETTE MI
49855-5406
US

IV. Provider business mailing address

467 N BASIN DR
NEGAUNEE MI
49866-9588
US

V. Phone/Fax

Practice location:
  • Phone: 906-226-4618
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number345935
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: