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General NPI Number Information
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NPI Number | 1912845934
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Entity Type | Individual
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Provider Name | SOPHIA GUNDRUM
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Gender | Female
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Dates
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Enumeration Date | 03/23/2026
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Last Update Date | 03/23/2026
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Provider Practice Location Address
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Address Line | 495 E MAIN ST STE A
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City | COLUMBUS
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State | OH
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Zip | 43215-5779
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Country | US
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Telephone | 614-355-8055
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Fax |
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Provider Business Mailing Address
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Address Line | 4980 VICKSBURG LN
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City | HILLIARD
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State | OH
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Zip | 43026-5740
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Country | US
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Telephone |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | S.2504106-TRNE
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License Number State | OH
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