Provider Demographics
NPI:1023161213
Name:SODMAN, CAROL JEAN (RNC WHNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:JEAN
Last Name:SODMAN
Suffix:
Gender:F
Credentials:RNC WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 E. EIGHTH STREET
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-2936
Mailing Address - Country:US
Mailing Address - Phone:231-929-1844
Mailing Address - Fax:231-949-2084
Practice Address - Street 1:1135 E 8TH ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2936
Practice Address - Country:US
Practice Address - Phone:231-929-1844
Practice Address - Fax:231-949-2084
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704097679363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5008704830OtherBLUE CROSS BLUE SHIELD