Individual
AMANDA SOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
211 JB WISE PL, WATERTOWN, NY 13601-2507
(315) 782-7445
Mailing address
1704 STATE ST, WATERTOWN, NY 13601-3102
(315) 782-7445
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
456879
NY
Other
Enumeration date
10/25/2023
Last updated
10/25/2023
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