Healthcare Provider Details

I. General information

NPI: 1427166552
Provider Name (Legal Business Name): SOPHIA CHU RODGERS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 ACADEMY RD NE #340
ALBUQUERQUE NM
87111-7372
US

IV. Provider business mailing address

10400 ACADEMY RD NE #340
ALBUQUERQUE NM
87111-7372
US

V. Phone/Fax

Practice location:
  • Phone: 505-298-1558
  • Fax: 505-298-7012
Mailing address:
  • Phone: 505-298-1558
  • Fax: 505-298-7012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR19106
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: