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General NPI Number Information
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NPI Number | 1396568838
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Entity Type | Individual
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Provider Name | REBECCA ANNE SOPELAK
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Gender | Female
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 115 WATERBURY RD
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City | PROSPECT
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State | CT
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Zip | 06712-1254
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Country | US
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Telephone | 203-758-5660
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Fax |
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Provider Business Mailing Address
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Address Line | 4 TERRIE RD
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City | FARMINGTON
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State | CT
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Zip | 06032-2422
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Country | US
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Telephone | 860-490-4012
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 12.013507
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License Number State | CT
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