Provider Demographics
NPI:1548743057
Name:FOSSO, ALINE BEATRICE (RN)
Entity Type:Individual
Prefix:
First Name:ALINE
Middle Name:BEATRICE
Last Name:FOSSO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 AMHURST DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-3198
Mailing Address - Country:US
Mailing Address - Phone:972-363-3204
Mailing Address - Fax:
Practice Address - Street 1:4102 AMHURST DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-3198
Practice Address - Country:US
Practice Address - Phone:972-363-3204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX950993163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse