Provider Demographics
NPI:1871386326
Name:MACK, SOPHIE SOLTES (NP)
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:SOLTES
Last Name:MACK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 SAWTOOTH OAK DR
Mailing Address - Street 2:
Mailing Address - City:LANDIS
Mailing Address - State:NC
Mailing Address - Zip Code:28088-1475
Mailing Address - Country:US
Mailing Address - Phone:206-557-0833
Mailing Address - Fax:
Practice Address - Street 1:609 SAWTOOTH OAK DR
Practice Address - Street 2:
Practice Address - City:LANDIS
Practice Address - State:NC
Practice Address - Zip Code:28088-1475
Practice Address - Country:US
Practice Address - Phone:206-557-0833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5022254363LA2100X
NC309953163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse