MEDICARE: SOPHIA LOREN HUNTER

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
1	163W00000X	Registered Nurse	2003006946	MO

General Provider Information

NPI Number	:	1477240380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA LOREN HUNTER

Provider Business Mailing Address
First Line	:	221 MERRIWEATHER LN
Second Line	:
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-2432
Country	:	US
Telephone Number	:	618-447-6946
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 MERRIWEATHER LN
Second Line	:
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-2432
Country	:	US
Telephone Number	:	618-447-6946
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2023
Last Update Date	:	04/20/2023

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