Provider Demographics
NPI:1962904367
Name:SOPHIS, MOLLY ELIZABETH (CNP)
Entity type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:ELIZABETH
Last Name:SOPHIS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MS
Other - First Name:MOLLY
Other - Middle Name:ELIZABETH
Other - Last Name:PLUNKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:10 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01510-1324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:792 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MA
Practice Address - Zip Code:01510-1608
Practice Address - Country:US
Practice Address - Phone:978-368-7631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2286705363LF0000X
MARN2286705363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily