Provider Demographics
NPI:1619511235
Name:SOBOYEDE, WOSILAT ABOSEDE
Entity Type:Individual
Prefix:
First Name:WOSILAT
Middle Name:ABOSEDE
Last Name:SOBOYEDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3064 ASARUM CT
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-5408
Mailing Address - Country:US
Mailing Address - Phone:651-354-8544
Mailing Address - Fax:
Practice Address - Street 1:3064 ASARUM CT
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-5408
Practice Address - Country:US
Practice Address - Phone:651-354-8544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6813363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily