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General NPI Number Information
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NPI Number | 1689325144
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Entity Type | Individual
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Provider Name | SOPHIA C RAEVOURI
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Gender | Female
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Dates
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Enumeration Date | 01/15/2022
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 752 OFFICERS ROW
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City | VANCOUVER
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State | WA
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Zip | 98661-3845
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Country | US
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Telephone | 360-996-1071
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Fax | 360-938-5632
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Provider Business Mailing Address
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Address Line | 2807 N PIONEER CANYON DR
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City | RIDGEFIELD
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State | WA
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Zip | 98642-7524
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Country | US
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Telephone | 609-961-0713
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Fax | 360-938-5632
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP61370244
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License Number State | WA
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