Provider Demographics
NPI:1407431513
Name:TOSSOU, ANTOINETTE (QSP)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:TOSSOU
Suffix:
Gender:F
Credentials:QSP
Other - Prefix:
Other - First Name:ANTOINETTE
Other - Middle Name:
Other - Last Name:TOSSOU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:948 EAGLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-8449
Mailing Address - Country:US
Mailing Address - Phone:701-729-6363
Mailing Address - Fax:
Practice Address - Street 1:948 EAGLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-8449
Practice Address - Country:US
Practice Address - Phone:701-729-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant