Healthcare Provider Details

I. General information

NPI: 1679190383
Provider Name (Legal Business Name): EMMA SOY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1914 J N PEASE PL
CHARLOTTE NC
28262-4504
US

IV. Provider business mailing address

5600 CROWN HILL DR
MINT HILL NC
28227-5550
US

V. Phone/Fax

Practice location:
  • Phone: 704-209-5040
  • Fax:
Mailing address:
  • Phone: 847-340-6546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number319867
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: