Individual
LISA CORINNE SOFOCLEOUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
250 BRODBELT LN APT 204, COLUMBUS, OH 43215-2458
(330) 540-7636
Mailing address
250 BRODBELT LN APT 204, COLUMBUS, OH 43215-2458
(330) 540-7636
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN.CNP.025876
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
APRN.CNP.025876
OHIO BOARD OF NURSING
OH
01
—
F08190884
OHIO BOARD OF NURSING
OH
Enumeration date
01/08/2020
Last updated
01/08/2020
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