Provider Demographics
NPI:1427166552
Name:RODGERS, SOPHIA CHU (CNP)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:CHU
Last Name:RODGERS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 ACADEMY RD NE
Mailing Address - Street 2:#340
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-7372
Mailing Address - Country:US
Mailing Address - Phone:505-298-1558
Mailing Address - Fax:505-298-7012
Practice Address - Street 1:10400 ACADEMY RD NE
Practice Address - Street 2:#340
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-7372
Practice Address - Country:US
Practice Address - Phone:505-298-1558
Practice Address - Fax:505-298-7012
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR19106363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP00278039OtherRAILROAD MEDICARE
NMQ5234Medicaid
NMNM016885OtherBCBS OF NM
NMQ5234Medicaid