Sophia Kennen Giacomelli
Nurse Practitioner in Medford, OR. Individual provider (NPI-1).
NPI number1124736764
StatusActive
Last updated in NPPESOct 7, 2025
Details
- NPI
- 1124736764
- Entity type
- Individual (NPI-1)
- Name
- Ms. Sophia Kennen Giacomelli
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Nov 14, 2022
- Certification date
- Oct 7, 2025
- Last updated
- Oct 7, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363L00000X | Nurse Practitioner | 10048417 | OR | Yes |
Practice location
3617 S Pacific HwyMedford, OR 97501-8957
Phone 541-535-6239
Mailing address
931 Chevy WayMedford, OR 97504-4127
Other practice locations
638 Market St
Medford, OR 97504-6126
Medford, OR 97504-6126
Phone 541-535-6239
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