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General NPI Number Information
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NPI Number | 1891041968
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Entity Type | Individual
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Provider Name | SOPHIE THIBODEAU ECKERT NP
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Gender | Female
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Dates
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Enumeration Date | 07/26/2012
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Last Update Date | 04/25/2017
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Provider Practice Location Address
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Address Line | 2003 MEDICAL PKWY SUITE 250
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7992
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Country | US
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Telephone | 410-224-2228
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Fax |
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Provider Business Mailing Address
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Address Line | 2003 MEDICAL PKWY SUITE 250
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7992
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Country | US
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Telephone | 410-224-2228
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | RN2274306
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | R208808
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License Number State | MD
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