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General NPI Number Information
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NPI Number | 1730801531
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Entity Type | Individual
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Provider Name | SOPHIE JACKSON RN, CNM
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Gender | Female
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 06/29/2026
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Provider Practice Location Address
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Address Line | 123 SUMMER ST STE 150
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City | WORCESTER
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State | MA
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Zip | 01608-1216
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Country | US
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Telephone | 508-368-3110
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Fax |
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Provider Business Mailing Address
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Address Line | 123 SUMMER ST STE 150
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City | WORCESTER
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State | MA
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Zip | 01608-1216
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Country | US
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Telephone | 508-368-3110
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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 | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | RN10000713
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN315147
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN10000713
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License Number State | MA
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