Provider Demographics
NPI:1275955957
Name:SOSSAMON, WESLEY CHASE (CRNA)
Entity Type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:CHASE
Last Name:SOSSAMON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 E BASELINE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2736
Mailing Address - Country:US
Mailing Address - Phone:480-565-8045
Mailing Address - Fax:480-407-6551
Practice Address - Street 1:4001 E BASELINE RD STE 102
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2736
Practice Address - Country:US
Practice Address - Phone:480-565-8045
Practice Address - Fax:480-407-6551
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR82917163W00000X
ARC003028367500000X
AZ1403367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse