Provider Demographics
NPI:1629553136
Name:SOSSAMAN, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SOSSAMAN
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 1:1827 MADELINE ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77562-2407
Mailing Address - Country:US
Mailing Address - Phone:281-684-9902
Mailing Address - Fax:
Practice Address - Street 1:1827 MADELINE ST
Practice Address - Street 2:
Practice Address - City:HIGHLANDS
Practice Address - State:TX
Practice Address - Zip Code:77562-2407
Practice Address - Country:US
Practice Address - Phone:281-684-9902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX949529163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse