MEDICARE: SOPHIE DRAYTON RN

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	R239145	MD

General Provider Information

NPI Number	:	1831921014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIE DRAYTON RN

Provider Business Mailing Address
First Line	:	3401 W PAYTON PL APT 223
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-1287
Country	:	US
Telephone Number	:	240-501-3792
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 W PAYTON PL APT 223
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-1287
Country	:	US
Telephone Number	:	240-501-3792
Fax Number	:

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

Provider Enumeration Date	:	08/16/2024
Last Update Date	:	08/16/2024

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