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NPI Code Detail

MEDICARE: MRS. SOPHIA LUCILLE WILMOT FNP-C

MEDICARE: MRS. SOPHIA LUCILLE WILMOT FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerR225015MD

General Provider Information

NPI Number : 1225402969
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SOPHIA LUCILLE WILMOT FNP-C
Provider Business Mailing Address
First Line : 9402 PROSPECT HILL PL
Second Line :
City : FREDERICK
State : MD
Zip : 21704-7341
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10715 CHARTER DR STE 130
Second Line :
City : COLUMBIA
State : MD
Zip : 21044-2892
Country : US
Telephone Number : 443-653-1363
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2015
Last Update Date : 08/03/2021

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